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-  2018 

带蒂胸肩峰动脉嵌合穿支肌皮瓣修复下咽环周缺损

DOI: doi:10.7507/1002-1892.201802017

Keywords: 下咽重建, 环周缺损, 胸肩峰动脉, 穿支皮瓣, 嵌合皮瓣, 胸大肌皮瓣

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Abstract:

目的 探讨带蒂胸肩峰动脉嵌合穿支肌皮瓣修复下咽环周缺损的临床效果。 方法 2013 年 1 月—2014 年 12 月,采用带蒂胸肩峰动脉嵌合穿支肌皮瓣修复 8 例复杂性下咽环周缺损患者。男 6 例,女 2 例;年龄 45~80 岁,平均 57 岁。均为外院治疗后下咽癌复发者,结束治疗至复发确诊时间为 3~28 个月,平均 16.5 个月。按国际抗癌联盟(UICC)TNM 分类分期:T2N1M0 3 例,T3N1M0 2 例,T3N2M0 1 例,T4N1M0 2 例。全喉全下咽切除术后,下咽环周缺损范围为 9.0 cm×8.5 cm~12.0 cm×10.5 cm;带蒂胸肩峰动脉嵌合穿支肌皮瓣的穿支皮瓣皮岛范围为 7.0 cm×4.0 cm~9.5 cm×6.0 cm,胸大肌肌皮瓣皮岛范围为 9.0 cm×5.0 cm~14.5 cm×6.0 cm。供区均直接拉拢缝合。 结果 术后皮瓣顺利成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合,无早期相关并发症发生。患者住院时间 12~22 d,平均 14.5 d。术后 8 周患者均恢复正常饮食。患者均获随访,随访时间 12~45 个月,平均 18.7 个月。所有患者颈部外形良好,未见肿瘤复发,未发生咽瘘、切口裂开和肿胀等情况,皮瓣不臃肿,重建的下咽腔无狭窄。供区仅遗留线性瘢痕,胸大肌功能未见明显影响。 结论 复杂的下咽环周缺损往往存在颈部受区血管缺如情况,不适合采用游离组织瓣移植修复,带蒂胸肩峰动脉嵌合穿支肌皮瓣可以作为一种局部重建替代治疗方案

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