半侧舌根组织瓣在咽腔侧方缺损修复中的应用

doi:10.6040/j.issn.1673-3770.0.2019.502

摘要/Abstract

摘要： 目的探讨下咽癌切除后应用半侧舌根组织瓣修复咽腔侧方缺损的效果。方法回顾性分析 2014年10月~2016年4月于山东大学齐鲁医院(青岛)行下咽癌切除并同期行半侧舌根组织瓣修补咽腔侧方缺损患者36例,其中梨状窝癌29例,下咽后壁癌7例,肿瘤均累及咽腔侧方。临床分期:Ⅱ期3例,Ⅲ期7例,ⅣA期25例,ⅣB期1例。统计并分析患者3年生存率、术后并发症发生率、咽喉功能恢复情况及喉功能保留率。结果所有患者肿瘤完整切除,病理示切缘阴性,均保留喉功能,吞咽、吞咽保护功能好(均于术后10~14 d拔除鼻饲管,顺利经口进食)。其中34例患者顺利拔除气管套管,气管套管拔除率94.4%。术后咽瘘发生1例,经短期换药后愈合,咽瘘发生率2.8%。36例患者3年生存率69.4%。结论半侧舌根组织瓣就近取材,操作简便,咽瘘发生率低,在咽腔侧方缺损修复中符合解剖及功能重建的要求。

关键词: 下咽癌, 手术治疗, 舌瓣, 修复, 组织瓣

Abstract: Objective To investigate the effect of repairing lateral defects of the pharyngeal cavity caused after resection of hypopharyngeal carcinoma by using the hemi-tongue flap. Methods A retrospective analysis was performed to evaluate 36 cases of hypopharyngeal carcinoma who had undergone complete tumor resection and were simultaneously treated for hypopharyngeal wall defects in the Qilu Hospital of Shandong University(Qingdao)from October 2014 to April 2016. The cohort included 29 cases of cancer of the piriform fossa and 7 cases of cancer of the posterior pharyngeal wall. The lateral pharyngeal wall was entirely invaded by the tumor. On performing a clinical staging, 3 cases were of stage Ⅱ, 7 of stage Ⅲ, 25 of stage ⅣA, and 1 of stage ⅣB. Three-year survival rate, postoperative complication rate, recovery of throat function, and retention of laryngeal function were analyzed. Results All cases had negative pathologic incisions, and all patients retained laryngeal function, with good swallowing and swallowing protective functions(the nasogastric feeding tube was removed 10 to 14 days after surgery, and oral feeding was smooth). Tracheal cannula was successfully removed in 34 patients, with a removal rate of 94.4%. Postoperative pharyngeal fistula occurred in 1 case, which was healed after short-term dressing, so the incidence of pharyngeal fistula was 2.8%. The above 36 patients had a 3-year survival rate of 69.4%. Conclusion The hemi-tongue root flap is close to the site of pathology, easy to maneuver, and leads to a lesser incidence of pharyngeal fistula. It fulfils the requirements of anatomical and functional reconstruction in the repair of lateral pharyngeal defects.

Key words: Hypopharyngeal carcinoma, Surgical treatment, Tongue flap, Repair, Tissue flap

中图分类号:

R766.7

岳建林,林云,姜震,李学新,孙睿杰,潘新良,刘大昱. 半侧舌根组织瓣在咽腔侧方缺损修复中的应用[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 63-66.

YUE Jianlin, LIN Yun, JIANG Zhen, LI Xuexin, SUN Ruijie, PAN Xinliang, LIU Dayu. Application of the hemi-tongue root flap for the repair of lateral defects in the pharyngeal cavity[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 63-66.

参考文献

[1] 潘新良, 雷大鹏, 许风雷, 等. 下咽癌的外科治疗[J]. 山东大学耳鼻喉眼学报, 2007, 21(1): 1-7.
[2] 崔晓波. 诱导化疗在局部晚期下咽癌治疗中的意义[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 10-17. doi:10.6040/j.issn.1673-3770.1. 2019.027. CUI Xiaobo. Significance of induction chemotherapy in late treatment of locally advanced hypo-pharyngeal cancer[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 10-17. doi:10.6040/j.issn.1673-3770.1. 2019.027.
[3] 潘新良. 声门旁间隙入路梨状窝癌切除术[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 1-3.doi: 10.6040/j.issn.1673-3770.0. 2016.232. PAN Xinliang. Surgical management of pyriform sinus carcinoma via the glottis adjacent space approach[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(3): 1-3. doi: 10.6040/j.issn.1673-3770.0. 2016.232.
[4] 沈志森, 李幼珍, 成立新, 等. 喉癌下咽癌患者下咽及颈段食管术后缺损的修复方法[J]. 临床耳鼻咽喉科杂志, 2002, 16(2): 68-70. doi: 10.3969/j.issn.1001-1781. 2002.02.008. SHEN Zhisen, LI Youzhen, CHENG Lixin, et al. Hypopharyngeal and cervical esophageal repairing[J]. J Clin Otorhinolaryngol, 2002, 16(2): 68-70. doi: 10.3969/j.issn.1001-1781. 2002.02.008.
[5] Hanasono MM, Matros E, Disa JJ. Important aspects of head and neck reconstruction[J]. Plast Reconstr Surg, 2014, 134(6): 968e-980e. doi:10.1097/prs.0000000000000722.
[6] 周奕彤, 金春顺. 舌瓣在喉、喉咽部分切除重建中的作用[J]. 国际耳鼻咽喉头颈外科杂志, 2011(5): 283-284. doi: 10.3760/cma.j.issn.1673-4106. 2011.05.010.
[7] 韩跃峰, 陈德尚, 李慧, 等. 舌瓣一期修复喉癌及喉咽癌术后咽部缺损[J]. 中国修复重建外科杂志, 2012, 26(10): 1206-1208. HAN Yuefeng, CHEN Deshang, LI Hui, et al. One-stage repair of pharyngeal defect using tongue flaps after resection of advanced stage hypopharyngeal neoplasm and laryngeal neoplasm[J]. Chin J Reparative Reconstr Surg, 2012, 26(10): 1206-1208.
[8] 张庆泉, 邢建萍, 宋西成, 等. 舌瓣修复咽喉术后缺损的临床研究[J]. 中华耳鼻咽喉科杂志, 2000, 35(5): 371. doi: 10.3760/j.issn:1673-0860. 2000.05.015. ZHANG Qingquan, XING Jianping, SONG Xicheng, et al. The clinical study of tongue flaps repairing after resecting pharyngeal neoplasm and laryngeal neoplasm[J]. Chin J Otorhinolaryngol, 2000, 35(5): 371. doi: 10.3760/j.issn:1673-0860. 2000.05.015.
[8] 张庆泉, 邢建萍. 舌瓣修复咽喉术后缺损的临床研究[J]. 中华耳鼻咽喉科杂志, 2000(5): 371-373. ZHANG Qingquan, XING Jianping. The clinical study of tongue flaps repairing after resecting pharyngeal neoplasm and laryngeal neoplasm[J]. Chin J Otorhinolaryngol, 2000(5): 371-373.
[9] Sambataro G, Oldini C, Mazzola RF. Reconstruction of the hypopharynx following extensive loss of mucosa[J]. Laryngoscope, 1984, 94(5 Pt 1): 671-676.doi: 10.1288/00005537-198405000-00018.
[10] 张庆泉, 王天铎, 任忠, 等. 舌瓣及残喉黏膜联合修复喉咽腔[J]. 中国耳鼻咽喉颅底外科杂志, 1997, 3(4): 252.
[11] 曹轶倓, 周梁, 吴海涛, 等.下咽癌386例临床特征及疗效分析[J].中华耳鼻咽喉头颈外科杂志, 2016, 51(6):433-439.
[12] 于萍,李佳原,杨晓菊,等.下咽鳞状细胞癌根治术后患者随访分析及生活质量调查[J].中国医药, 2019, 14(7):2086-2090.
[13] 田皞, 喻建军, 李赞, 等. 常见组织瓣在头颈外科缺损修复中的应用[J]. 中国耳鼻咽喉颅底外科杂志, 2015, 21(6): 489-492.doi: CNKI:SUN:ZEBY.0.2015-06-018.
[14] 李文, 雷晓旭, 王艳, 等. 穿支游离皮瓣整复头颈部肿瘤术后缺损[J]. 临床耳鼻咽喉头颈外科杂志, 2011, 25(6): 252-254.doi: 10.3969/j.issn.1001-1781. 2011.06.005. LI Wen, LEI Xiaoxu, WANG Yan, et al. Free perforator flap transfer to reconstruct the defect resulted from resection of head and neck tumor[J]. J Clin Otorhinolaryngol Head Neck Surg, 2011, 25(6): 252-254. doi: 10.3969/j.issn.1001-1781. 2011.06.005.
[15] 潘新良, 栾信庸, 解光, 等. 胸大肌肌皮瓣在耳鼻咽喉头颈外科中的应用[J]. 山东大学耳鼻喉眼学报, 2005, 19(5): 277-282. doi: CNKI:SUN:SDYU.0. 2005-05-001. PAN Xinliang, LUAN Xinyong, XIE Guang, et al. Application of pectoralis major myocutaneous flap in otorhinolaryngology & head and neck surgery[J]. J Otolaryngol Ophthalmol Shandong Univ, 2005, 19(5): 277-282. doi: CNKI:SUN:SDYU.0. 2005-05-001.
[16] 何尚宽,徐达传,王增星,等. 舌瓣设计的解剖学基础[J]. 中国临床解剖学杂志, 1997, 15(1):4-6.
[17] 孙岩, 张天振, 张庆泉. 舌瓣的临床应用进展[J]. 山东大学耳鼻喉眼学报, 2007, 21(1): 20-23, 37.
[18] 潘新良, 关方霞, 栾信庸. 舌瓣在整复喉头缺损中的应用[J]. 耳鼻喉学报, 1998, 12(3): 137-139. PAN Xinliang, GUAN Fangxia, LUAN Xinyong. Tongue flap reconstruction of the laryngeal carcinoma after laryngectomy[J]. J Otolaryngol, 1998, 12(3): 137-139.

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