Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
Head Neck. 2010 Aug;32(8):1003-11. doi: 10.1002/hed.21290.
We sought to evaluate postoperative complications and functional outcomes in patients who underwent oropharyngeal reconstruction after oncologic resection.
The evaluation constituted a retrospective review of 65 patients who underwent microvascular free flap (85%) and/or pectoralis pedicled flap (18%) oropharyngeal reconstruction after composite resection for advanced oropharyngeal squamous cell carcinoma.
Perioperative mortality was 1.5%. Overall, 29 patients (45%) experienced surgical or medical complications; however, only 2 patients (3%) required operative intervention. The flap success rate was 100%. Eighty-six percent of patients were decannulated, 34% were able to meet all of their nutritional needs orally, and 69% attained >80% speech intelligibility. Preoperative swallowing impairment was associated with postoperative feeding tube dependence (p = .006).
Microvascular free flap and/or pectoralis pedicled flap reconstruction of extensive oropharyngeal defects is safe and reliable, even with advanced disease. Although most patients achieved decannulation and functional speech, almost two thirds remained at least partially feeding tube dependent.
我们旨在评估接受头颈肿瘤切除术后行口咽重建术患者的术后并发症和功能结果。
评估包括对 65 例因晚期口咽鳞状细胞癌行复合切除术而接受微血管游离皮瓣（85%）和/或胸大肌带蒂皮瓣（18%）口咽重建术的患者进行回顾性分析。
围手术期死亡率为 1.5%。总体而言，29 例（45%）患者发生手术或医疗并发症；但仅有 2 例（3%）需要手术干预。皮瓣成活率为 100%。86%的患者可拔管，34%的患者能够经口满足全部营养需求，69%的患者言语清晰度>80%。术前吞咽功能障碍与术后依赖饲管喂养有关（p=0.006）。
即使存在晚期疾病，广泛口咽缺损的微血管游离皮瓣和/或胸大肌带蒂皮瓣重建术是安全可靠的。尽管大多数患者可拔管和进行有功能的言语，但仍近三分之二的患者至少部分依赖饲管喂养。
