论文部分内容阅读
目的:探讨双蒂供血的胸大肌肌皮瓣在喉癌、下咽癌手术缺损修复中的应用。方法:应用胸大肌肌皮瓣一期重建喉癌和下咽癌术后缺损22例,均为初治患者。术中保留胸肩峰血管的胸肌支及胸外侧血管的分支,制备成起始部不含肌肉的双蒂血管筋膜束,肌皮瓣经锁骨下隧道至缺损区。术后密切观察颈部术区的皮下肿胀情况、引流物的量和颜色等,以排除术区血肿的发生,有怀疑时要及时探查。结果:22例患者胸大肌肌皮瓣全部成活,发生咽瘘2例,经换药后愈合;术后接受放疗21例,无继发肌皮瓣坏死。随访6~24个月,1例颈段食管环周缺损卷筒修复者,放疗后8个月出现吻合口狭窄,后行胃造瘘治疗;余21例吞咽功能恢复良好。13例保留喉功能患者,仅1例带管生存,拔管率92.3%,均无交流障碍。因随诊时间短,无死亡患者。结论:双蒂供血的胸大肌皮瓣,若血运得到充分保证,术后不需要复杂繁琐的设备来观察和监测皮瓣血运,仅排除可能导致肌皮瓣坏死的因素,即能保证胸大肌皮瓣的成活。
Objective: To investigate the application of pectoralis major myocutaneous flaps with double pedicle blood supply in the surgical repair of laryngeal and hypopharyngeal carcinoma. Methods: The pectoralis major myocutaneous flap was used to reconstruct the reconstructed laryngeal carcinoma and hypopharyngeal carcinoma in 22 cases, all of whom were newly diagnosed. Intraoperative preservation of the thoracolumbar blood vessels of the chest and thoracic branch of the blood vessels, prepared as the beginning of the muscle-free dual pedicle vascular fascia bundle, myocutaneous flap through the subclavian tunnel to the defect area. Close observation of the subcutaneous swelling of the neck area after operation, the amount of drainage and color, etc., in order to rule out the occurrence of hematoma area, in case of doubt to promptly probe. Results: Twenty - two cases of pectoralis major myocutaneous flap all survived, two cases of pharyngeal fistula occurred, which were healed after dressing change. Radiotherapy was performed in 21 cases without necrosis of myocutaneous flap. All the patients were followed up for 6-24 months. One patient with revascularization of cervical esophageal peritoneal defect had anastomotic stenosis at 8 months after radiotherapy and gastrostomy was performed after operation. The remaining 21 patients recovered well. Thirteen patients with preserved laryngeal function, only one case of survival of the tube, extubation rate of 92.3%, no exchange disorder. Due to short follow-up, no deaths. CONCLUSION: If the blood supply is fully guaranteed, the pedicled pectoralis major muscle flap with double pedicle blood supply can observe and monitor the blood supply of the flap without complex and cumbersome equipment after operation, and only exclude the factors that may lead to the necrosis of myocutaneous flap, Pectoralis major flap survival.