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-  2016 

带蒂胸肩峰动脉穿支皮瓣在放疗和全喉切除术后咽瘘修复的临床应用

DOI: doi:10.7507/1002-1892.20160255

Keywords: 胸肩峰动脉, 穿支皮瓣, 修复, 全喉切除术, 咽瘘

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Abstract:

目的探讨带蒂胸肩峰动脉穿支皮瓣在全喉切除术及放疗后咽瘘修复的临床疗效。 方法2012年2月-2015年1月应用带蒂胸肩峰动脉穿支皮瓣对8例全喉切除术及放疗后的咽瘘缺损进行修复重建。8例患者均为男性;年龄46~72岁,平均51.8岁。病程8~62个月,平均27.5个月。咽瘘缺损范围为4.0 cm×2.5 cm~6.0 cm×4.0 cm,颈部皮肤缺损范围为4.0 cm×3.0 cm~6.0 cm×4.0 cm。皮瓣大小为7.0 cm×4.0 cm×0.3 cm~9.5 cm×6.0 cm×0.5 cm。以胸肩峰动脉穿支为蒂的胸肩峰动脉穿支皮瓣血管蒂长度为(8.3±0.5)mm,其旋转点至受区中心距离为(894.5±1.9)mm。 结果8例皮瓣术后全部成活,切口均Ⅰ期愈合。住院时间7~14 d,平均9.6 d。改良吞钡试验未发现瘘或狭窄。患者均获随访,随访时间8~42个月,平均28.5个月。所有患者颈部外形良好,未见咽瘘复发或咽食管狭窄。胸部供区仅遗留线性瘢痕,胸大肌功能未见明显影响。患者均恢复了正常饮食。 结论全喉切除术后一旦发生咽瘘应早期修复,带蒂胸肩峰动脉穿支皮瓣适用于修复放疗和全喉切除术后的咽瘘缺损

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