摘要
目的分析比较舌骨下肌皮瓣修复口腔肿瘤术后缺损时不同手术操作要点及相应临床转归。方法回顾性分析四川省肿瘤医院头颈外科1994年5月—2007年3月完成27例舌骨下肌皮瓣修复口腔肿瘤术后缺损，男19例，女8例；16例口底鳞癌，7例舌鳞癌，4例舌根鳞癌；均为单侧舌骨下肌皮瓣，最大肌皮瓣4om×8cm。8例自肌皮瓣远端逆血管走行掀起并携带同侧胸锁乳突肌下1／3部分肌肉组织（逆行法肌皮瓣成形），19例先利用显微操作技巧顺血管走行解剖出血管蒂后掀起肌皮瓣（顺行法肌皮瓣成形）。27例中11例保留血管蒂及舌骨下肌在舌骨的附着（复合蒂），16例仅以甲状腺上动静脉为蒂，颈前静脉伴行（轴型血管蒂）；其中21例肌皮瓣制作时于面总静脉汇入点以远结扎颈内静脉远心端，并保留肌皮瓣内的颈前静脉（干预回流）。供区直接拉拢缝合。结果27例肌皮瓣中干预回流的21例全部成活，成活率77．8％；2例肌皮瓣全部坏死，4例肌皮瓣部分皮肤坏死，这6例均为携带了同侧胸锁乳突肌的逆行法复合蒂肌皮瓣成形，坏死原因均为静脉回流障碍。顺行法成形的19例舌骨下肌皮瓣全部成活，其中采用轴型血管蒂的16例肌皮瓣全部成活。随访9个月至13年，中位随访时间4年，失访4例，随访23例均未见复发于肌皮瓣的肿瘤。肿瘤原发灶复发3例，颈淋巴结复发6例，Kaplan．Meier法统计3年、5年累积生存率分别为69．8％和47．2％。结论为提高舌骨下肌皮瓣成活率，手术入路以顺行法肌皮瓣成形为宜，解剖轴型血管蒂力求遵循显微操作技术，特别应注意保证静脉回流。携带同侧胸锁乳突肌部分肌肉组织及保留舌骨下肌在舌骨的附着不会增加肌皮瓣的成活率。
Objective To compare different surgical techniques and clinical effectiveness using infrahyoid myocutaneous flap to restore effects after intraoral cancer surgery. Methods It is a retrospective study in Sichuan cancer hospital, from May 1994 to March 2007, 27 cases were treated surgically with unilateral infrahyoid myocutaneous falp, 19 males and 8 famales. Seven cases of squamous cell tongue carcinoma, 4 cases of tongue root carcinoma, 16 cases of mouth floor carcinoma. The biggest flap was 4 cm × 8 cm. In 8 cases, the flap was formed since the remote end reverse vascular traveling and carried with inferior 1/3 muscular tissue of the sternocleidomastoid muscle on the same side （ retrograde flap forming） , in 19 cases, vascular pedicla was anatomied with microscopic blood vessel-operating skills along vascular traveling before the flap forming（ anterograde flap forming）. Eleven cases of the reservation vascularized and infrahyoid muscles in the hyoid attachment （combination pedicle）, in 16 eases, the arteria and vena thyroidea superior reserved as the pedicel accompanied with the vena jugularis anterior （the axial vessle pedicle） ; in 21 cases, the distal end of the vena jugularis interna was tied up at the place where the vena facialis communis joins to the vena jugularis interna, and the vena jugularis anterior was reserved within the flap （ interference return）. Results The survival rate of total 27 cases are 77.8%. The flap necrosis in two cases of total group, 1/3 - 1/2 skin necrosis of the flap was found in 4 cases, in the six cases, flap was formed with retrograde flap forming carry with the ipsilateral sternocleidomastoid, the reason of necrosis was venous flow obstruction. Twenty-one flaps of interference return are all survived, the flap in 19 cases with anterograde flap forming all survived, and 16 cases of the axial infrahyoid flap all survived. Follow-up nine months to 13 years with a median follow-up time for four years. Lost four cases, 23 followed up cases did not found on the flap recurrence of cancer. The primary tumor recurrence in three cases, six cases of cervical lymph node recurrence, Kaplan-Meier method statistics 3,5-year survival rates were 69. 8%, 47. 2%, respectively. Conclusions To improve the survival rate, the surgical approach of anterograde flap forming is suitable, to anatomize the axial vessle pedicle with microscopic skills, in particular should pay attention to ensure that venous return. Carrying with the same side of the sternocleidomastoid muscle tissue and retaining hyoid attachment of infrahyoid muscles will not increase the survival rate of the muscle flap.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2008年第11期826-829,共4页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
