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目的探讨应用胸大肌肌皮瓣修复放疗后复发扁桃体癌术后缺损的临床效果。方法1998年1月-2005年12月,收治10例根治性放疗后复发的扁桃体癌患者。男8例,女2例;年龄43～68岁,平均58岁。鳞状细胞癌7例,未分化癌2例,腺样囊性癌1例。放疗前参照国际抗癌联盟1997年口咽癌的分期标准,均诊断为Ⅲ、Ⅳ期。患者于放疗后6～32个月复发。放疗后复发扁桃体癌侵及舌根、软腭、咽后壁、咽旁间隙、硬腭。肿瘤范围为4cm×2cm～8cm×5cm。7例伴淋巴结转移。术中彻底切除肿瘤后,切取大小为7cm×5cm～12cm×9cm的胸大肌肌皮瓣修复缺损。供区直接拉拢缝合。结果术后9例肌皮瓣全部成活,切口Ⅰ期愈合;1例胸大肌肌皮瓣部分坏死,经对症处理后愈合,遗留咽部缺损未予特殊处理。供区切口均Ⅰ期愈合。患者呼吸、发音及吞咽功能满意。10例术后均获随访,随访时间2年～5年8个月。其中3年生存率为66.7%(6/9),5年生存率为20.0%(1/5)。结论胸大肌肌皮瓣成活率高,安全可靠,操作简便,可修复较大面积软组织缺损,是修复放疗后复发扁桃体癌术后组织缺损的理想材料。
Objective To investigate the clinical effect of pectoralis major myocutaneous flap in the treatment of postoperative recurrence of tonsillar carcinoma after radiotherapy. Methods From January 1998 to December 2005, 10 patients with recurrent tonsillar carcinoma after radical radiotherapy were treated. 8 males and 2 females; aged 43 to 68 years, mean 58 years. Squamous cell carcinoma in 7 cases, undifferentiated carcinoma in 2 cases, adenoid cystic carcinoma in 1 case. Reference to the International Union Against Cancer in 1997 staging criteria for oropharyngeal cancer, were diagnosed as Ⅲ, Ⅳ period. Patients relapsed 6 to 32 months after radiotherapy. Tumor recurrence after radiotherapy Tonsil invasion, soft palate, pharyngeal wall, parapharyngeal space, the palate. Tumor range of 4cm × 2cm ~ 8cm × 5cm. 7 cases with lymph node metastasis. After radical resection of the tumor, the pectoralis major myocutaneous flap of 7cm × 5cm ~ 12cm × 9cm was cut to repair the defect. For the area directly draw suture. Results Nine cases of myocutaneous flaps survived, and the incisions healed in the first period. One case of pectoralis major myocutaneous flap was partially necrotic, healed by symptomatic treatment and the residual pharyngeal defect was not treated. District incision healed first. Patients breathing, pronunciation and swallowing satisfactory. All patients were followed up for 2 years to 5 years and 8 months. The 3-year survival rate was 66.7% (6/9), and the 5-year survival rate was 20.0% (1/5). Conclusion The pectoralis major myocutaneous flap has the advantages of high survival rate, safe and reliable operation, easy operation and repairing of large area soft tissue defect. It is an ideal material for repairing the tissue defect of postoperative recurrence of tonsillar carcinoma after radiotherapy.