摘要
目的系统评估颞骨-腮腺复合缺损的修复策略,比较局部肌瓣与游离皮瓣的临床适用性,为优化头颈部复杂缺损重建提供参考。方法回顾性分析2018年1月~2023年6月首都医科大学附属北京同仁医院收治的17例颞骨-腮腺区术后缺损患者病例资料,其中男性11例,女性6例,年龄42~72岁,中位年龄58岁。所有患者均行根治性手术,缺损修复采用局部组织瓣13例(颞肌瓣6例、胸锁乳突肌瓣3例、颏下颈阔肌瓣2例、颏下岛状皮瓣2例)或游离组织瓣4例(股前外肌筋膜瓣1例、股前外侧皮瓣1例、腹部游离脂肪筋膜瓣2例)。结果17例患者的原发疾病包括外耳道及腮腺恶性肿瘤(鳞状细胞癌6例,腺样囊性癌6例,导管癌3例)。所有皮瓣完全存活,1例颞肌瓣修复者术后发生切口感染,经清创换药后延期愈合。中位随访期16个月(4~29个月),2例(11.8%)外耳道鳞状细胞癌局部复发,1例(5.9%)腮腺导管癌术后9个月发生肺转移并于15个月后死亡,其余14例(82.4%)无瘤生存。功能评估显示局部组织瓣组修复时间短,但存在肌瓣旋转弧度受限;游离瓣组可精准匹配缺损形态,但手术时间延长至3.5~4.5 h。14例(82.4%)术后接受辅助放疗,放疗后组织瓣均未出现放射性坏死。结论颞骨-腮腺区复合缺损需兼顾术腔覆盖与外形修复双重需求。局部肌瓣操作简便、血供可靠,适用于中小型缺损;游离组织瓣在复杂三维缺损重建中更具形态适应性,但需显微外科技术支持。修复方案应根据缺损范围、血管条件及放疗计划综合决策,本组数据证实两类技术均能获得稳定疗效。
OBJECTIVE To systematically evaluate the repair strategies for temporal bone-parotid composite defects,compare the clinical applicability of local muscle flaps and free flaps,and provide references for optimizing the reconstruction of complex head and neck defects.METHODS We retrospectively analyzed the medical records of 17 patients with postoperative defects in the temporal bone-parotid region treated at Beijing Tongren Hospital,Capital Medical University,between January 2018 and June 2023.There were 11 males and 6 females,with a median age of 58 years(range:42-72 years).All patients had undergone radical resection.Defects were reconstructed with local flaps in 13 cases(temporalis muscle flap,n=6;sternocleidomastoid flap,n=3;submental platysma flap,n=2;submental island flap,n=2)and with free flaps in 4 cases(anterolateral thigh fascial flap,n=1;anterolateral thigh flap,n=1;free abdominal adipofascial flap,n=2).RESULTS The primary diseases of the 17 patients were malignant tumors of the external auditory canal and parotid gland(6 cases of squamous cell carcinoma,6 cases of adenoid cystic carcinoma,and 3 cases of ductal carcinoma).All flaps survived completely.One patient with temporalis muscle flap repair developed postoperative wound infection,which healed after debridement and dressing change.The median follow-up period was 16 months(4-29 months).Two cases(11.8%)of external auditory canal squamous cell carcinoma had local recurrence,one case(5.9%)of parotid ductal carcinoma developed pulmonary metastasis 9 months after surgery and died at 15 months.The remaining 14 cases(82.4%)were tumor-free survivors.Functional evaluation showed that the local tissue flap group had a shorter repair time,but was limited by muscle flap rotation arc;the free flap group could accurately match the defect shape,but the surgical time was prolonged to 3.5-4.5 hours.Fourteen cases(82.4%)received postoperative adjuvant radiotherapy.None of the tissue flaps developed radiation necrosis after radiotherapy.CONCLUSION Temporal bone-parotid composite defects need to balance the dual requirements of surgical cavity coverage and cosmetic repair.Local muscle flaps are easy to operate and have reliable blood supply,suitable for small and medium-sized defects;free tissue flaps have better shape adaptability in complex three-dimensional defect reconstruction,but require microsurgical technical support.The repair plan should be comprehensively decided based on the defect range,vascular conditions,and radiotherapy plan.The data of this group confirmed that both techniques can achieve stable therapeutic effects.
作者
杨征
房孝莲
周晶
陈学军
陈晓红
李平栋
YANG Zheng;FANG Xiaolian;ZHOU Jing;CHEN Xuejun;CHEN Xiaohong;LI Pingdong(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery(Capital Medical University),Ministry of Education,Beijing,100730,China)
出处
《中国耳鼻咽喉头颈外科》
2025年第7期413-417,共5页
Chinese Archives of Otolaryngology-Head and Neck Surgery
关键词
腮腺肿瘤
显微外科手术
外科皮瓣
颞骨缺损
局部肌瓣
游离皮瓣
修复重建
Parotid Neoplasms
Microsurgery
Surgical Flaps
temporal bone defect
local muscle flap
free flap
repair and reconstruction
