Repair surgical defect of squamous cell carcinoma of tongue base with advanced patients
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摘要: 目的:探讨中晚期舌根癌手术缺损的重建方法。方法:以30例中晚期舌根鳞状细胞癌患者为研究对象,T2N1M0 4例,T3N1M0 7例,T3N2M0 10例,T4N1M0 4例,T4N2M0 5例。原发灶手术方法:舌骨咽侧切开入路12例,下颌骨正中切开入路18例。全部病例均于术后4~6周放疗。结果:带蒂胸大肌肌皮瓣修复25例,所有肌皮瓣均成活,其中1例口内皮瓣与周围组织部分分离,1例肌皮瓣局部组织坏死,均经局部换药后愈合。游离股前外侧肌皮瓣修复5例,有1例肌皮瓣局部组织坏死,经口清除坏死组织至新鲜创面,二期愈合。18例保喉患者全部拔管。3年生存率为68%,局部控制率为87%。结论:胸大肌肌皮瓣和股前外侧肌皮瓣是舌根修复可选用的供区组织。最有效和可靠的重建方法应首选胸大肌肌皮瓣,股前外侧肌游离皮瓣供区隐蔽,也是一种有效的修复手段,但需要熟练的显微手术技术。Abstract: Objective: To repair the postoperative tissue defect of the base of tongue cancer in advanced patients.Method: There were 30 patients of medium-high differentiation squamous cell carcinoma(SCC) included in this study. According to the TNM staging of AJCC 2002,there were 4 cases of T2N1M0, 7 of T3N1M0, 10 of T3N2M0, 4 of T4N1M0 and 5 of T4N2M0. Surgical approach of the primary lesion: 12 with transhyoidpharyngotomy approach and 18 with mandibulotomy approach. All cases accepted radiotherapy 4-6 weeks after surgery.Result: Twenty-five cases were reconstructed with pedicle pectoralis major myocutaneous flaps, and all them survived. Among them,1 flap was partial split with surrounding tissue spontaneously, and another flap had partial tissue necrosis, however,both flaps grew well with dressing and other local treatment. Other 5 cases were reconstructed with free anterolateral myocutaneous flaps. Among them, 1 flap had partial tissue necrosis, but had a secondary healing after removing necrotic tissue via mouth approach. All 18 patients of larynx-preservation had tracheal tube pulled out. The 3-year survival rate was 68% and the local control rate was 87%.Conclusion: Pedicle pectoralis major myocutaneous flaps and free anterolateral myocutaneous flaps were alternative donor area for repairing postoperative tissue defect of the base of tongue; The former was preferred,and the latter was concealed so as to be a kind of effective method, which need adept technique of microsurgery.
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Key words:
- base of tongue /
- squamous cell carcinoma /
- surgery /
- reconstruct
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