Rampazzo Antonio, Salgado Christopher J, Gharb Bahar Bassiri, Mardini Samir, di Spilimbergo Stefano Spanio, Chen Hung-Chi
Taiwan, Republic of China; Cleveland, Ohio; and Rochester, Minn. From the Department of Plastic Surgery, E-Da Hospital, I-Shou University, the Department of Plastic Surgery, University Hospitals Cleveland, Case Western Reserve University, and the Division of Plastic Surgery, Mayo Clinic.
Plast Reconstr Surg. 2008 Dec;122(6):186e-194e. doi: 10.1097/PRS.0b013e31818cc11e.
Radical excision of advanced hypopharyngeal and laryngeal tumors usually compromises both swallowing and speech. Among the available reconstruction methods, the free ileocolon flap allows rehabilitation of both functions in one stage. The donor-site morbidity of this flap has not been addressed in head and neck cancer patients.
A retrospective study was conducted in 34 patients between April of 2003 and December of 2007 to investigate donor-site morbidity in patients undergoing reconstruction with free ileocolon flaps. Complications such as diarrhea, upper gastrointestinal tract distress, bowel leak, abscess, or hernia formation were evaluated. Significant association of diarrhea and upper gastrointestinal distress, previous abdominal operations, systemic diseases, primary versus secondary reconstruction, flap length, and postoperative chemotherapy were subsequently evaluated. Differences were considered significant for values of p <or= 0.05.
There were no perioperative or postoperative deaths. Nineteen patients (56 percent) experienced temporary diarrhea. In all but two patients, diarrhea discontinued by 4 months. Chemotherapy was significantly associated with diarrhea (p < 0.01). Colchicine, terbinafine, and heroin withdrawal episodically caused diarrhea but statistical conclusions could not be drawn. Six patients (18 percent) suffered from upper gastrointestinal tract problems (gastroduodenal ulcer, erosive gastritis, and minor bleeding), probably because of insufficient gastric protection.
The free ileocolon flap proved to be a reliable method when simultaneous restoration of swallowing and speech was required, with donor-site morbidity comparable to that of the other intestinal flaps.
晚期下咽和喉肿瘤的根治性切除通常会影响吞咽和言语功能。在现有的重建方法中，游离回结肠瓣可一期恢复这两种功能。头颈部癌患者中尚未涉及该瓣供区的并发症情况。
对2003年4月至2007年12月期间的34例患者进行回顾性研究，以调查接受游离回结肠瓣重建患者的供区并发症情况。评估腹泻、上消化道不适、肠漏、脓肿或疝形成等并发症。随后评估腹泻与上消化道不适、既往腹部手术、全身性疾病、一期与二期重建、瓣长度及术后化疗之间的显著相关性。p≤0.05时差异具有统计学意义。
围手术期及术后均无死亡病例。19例患者（56%）出现暂时性腹泻。除2例患者外，所有患者腹泻在4个月内停止。化疗与腹泻显著相关（p<0.01）。秋水仙碱、特比萘芬及海洛因戒断偶尔会引起腹泻，但无法得出统计学结论。6例患者（18%）出现上消化道问题（胃十二指肠溃疡、糜烂性胃炎及少量出血），可能是由于胃保护不足。
当需要同时恢复吞咽和言语功能时，游离回结肠瓣是一种可靠的方法，其供区并发症与其他肠瓣相当。
