论文部分内容阅读
目的探讨不同情况下应用胸大肌肌皮瓣(PMF)修复下咽颈食管区域重要和复合缺损的方法和可行性。方法采用PMF单独或联合其他修复方法,结合对修复方法的改良,采用不同方式修复晚期和复发性下咽癌和喉癌侵犯下咽颈食管区域手术切除术后下咽颈食管巨大和复合性缺损59例,缺损类型包括下咽颈食管部分缺损、下咽颈食管环周缺损以及下咽颈食管缺损合并颈前软组织巨大复合缺损。结果完成单纯PMF覆盖法26例,椎前筋膜游离植皮加PMF覆盖4例,PMF覆盖加颈前表面游离植皮2例,PMF覆盖下咽加胸三角皮瓣(DPF)修复颈前缺损2例,单纯PMF皮管16例,PMF皮管加肩胸皮瓣表面覆盖4例,胃上提加PMF覆盖3例,双岛瓦合PMF2例。术后20例出现了不同程度并发症,除1例院内死亡外,其余均经妥善处理治愈,恢复吞咽功能。结论PM F适合各种情况的下咽颈食管缺损修复,特别是在颈部同时伴有巨大软组织复合缺损时,这种方法更具优越性。
Objective To explore the feasibility and feasibility of using pectoralis major myocutaneous flap (PMF) to repair the important and complex defects of the pharyngeal neck and esophagus under different conditions. Methods PMF alone or in combination with other repair methods, combined with the improvement of the repair method, using different ways to repair advanced and recurrent hypopharyngeal cancer and laryngeal cancer invade the lower pharyngeal esophageal region after surgical resection of the hypopharyngeal giant esophageal and composite defects 59 cases, the type of defect, including the hypopharyngeal part of the esophagus, hypopharyngeal neck, esophageal perineal defect and hypopharyngeal esophageal defect combined with cervical huge soft tissue defects. Results There were 26 cases of simple PMF covering method, 4 cases of PMF covered by PMF and 2 cases of free skin graft on the anterior surface of cervical spine. Two cases of anterior cervical defect were repaired by PMF and thoracic triangular flap (DPF) , 16 cases of pure PMF skin tube, 4 cases of PMF skin tube and shoulder-and-thoracic skin flap, 3 cases of PMF and 2 cases of PMF2. There were 20 cases of postoperative complications of varying degrees, in addition to a hospital death, the rest have been properly treated to cure swallowing recovery. Conclusion PM F is suitable for all cases of hypopharyngeal neck esophageal defect repair, especially in the neck accompanied by huge soft tissue defects, this method is more superior.