Chepeha Douglas B, Annich Gail, Pynnonen Melissa A, Beck Jill, Wolf Gregory T, Teknos Theodoros N, Bradford Carol R, Carroll William R, Esclamado Ramon M
Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor 48109-0312, USA.
Arch Otolaryngol Head Neck Surg. 2004 Feb;130(2):181-6. doi: 10.1001/archotol.130.2.181.
To evaluate the factors related to surgical complications, rate of gastrostomy tube (G-tube) dependence, and hospitalization in patients undergoing reconstruction with a pectoralis myocutaneous flap vs a soft-tissue revascularized flap.
Quasi-experimental case series with a historic control group.
A total of 179 patients (138 men and 41 women) with a mean (SD) age of 58 (14) years treated between January 1, 1986, and December 31, 1995, with a pectoralis flap (108 patients) or a revascularized free flap (71 patients).
Inclusion criteria were first or second extirpation, reconstruction with soft-tissue flap, or defect including the upper aerodigestive tract. Exclusion criteria were secondary reconstruction, or reconstruction for salvage of a complication.
Although the major complication rate was not significantly different according to reconstructive approach, hypopharyngeal defects had a significantly higher major complication rate of 30% (6/20) compared with 8% (13/159) for other defect sites (P<.003). The minor complication rate was higher in the pectoralis group, at 57% (62/108), than in the revascularized flap group, at 21% (15/71) (P<.001). G-tube dependence was higher in the pectoralis group at 42% (40/96), in contrast to the revascularized flap group at 16% (10/63) (P<.001). G-tube dependence was 25% higher in patients who underwent salvage surgery after radiation (42% [30/72]) than in patients treated with postoperative radiation (17% [12/69]) (P<.004). Revascularized flaps helped ameliorate the effects of radiation before surgery; 56% (23/41) of the patients who received pectoralis flaps were G-tube dependent, while the rate of G-tube dependence in the revascularized flap group was 23% (7/31) (P<.004). Hospitalization was longer in the pectoralis group (14 days) than the revascularized flap group (12 days) (P<.006).
Patients who undergo reconstruction with a pectoralis flap have significantly higher minor complication rates, a higher rate of G-tube dependence, and longer hospitalization than patients who undergo reconstruction with a soft-tissue revascularized flap.
评估胸大肌肌皮瓣与软组织血管化皮瓣重建患者手术并发症相关因素、胃造瘘管（G管）依赖率及住院情况。
有历史对照组的准实验性病例系列研究。
1986年1月1日至1995年12月31日期间共179例患者（138例男性和41例女性），平均（标准差）年龄58（14）岁，采用胸大肌皮瓣（108例患者）或血管化游离皮瓣（71例患者）进行治疗。
纳入标准为首次或二次切除、软组织皮瓣重建或包括上消化道呼吸道的缺损。排除标准为二次重建或因并发症补救而进行的重建。
尽管根据重建方法主要并发症发生率无显著差异，但下咽缺损的主要并发症发生率显著更高，为30%（6/20），而其他缺损部位为8%（13/159）（P<0.003）。胸大肌组的轻微并发症发生率更高，为57%（62/108），高于血管化皮瓣组的21%（15/71）（P<0.001）。胸大肌组的G管依赖率更高，为42%（40/96），而血管化皮瓣组为16%（10/63）（P<0.001）。放疗后接受补救手术的患者G管依赖率比术后放疗患者高25%（42%[30/72]比17%[12/69]）（P<0.004）。血管化皮瓣有助于改善术前放疗的影响；接受胸大肌皮瓣的患者中有56%（23/41）依赖G管，而血管化皮瓣组的G管依赖率为23%（7/31）（P<0.004）。胸大肌组的住院时间（14天）比血管化皮瓣组（12天）更长（P<0.006）。
与采用软组织血管化皮瓣重建的患者相比，采用胸大肌皮瓣重建的患者轻微并发症发生率显著更高、G管依赖率更高且住院时间更长。
