Ma Shiyin, Han Yuefeng, Wang Wenzhong, Zhang Mingjie, Wang Wei, Zhou Lanzu
Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233000, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 May;24(5):556-8.
To discuss and value the effects and the advantages of pectoralis major myocutaneous flap in repair of defect caused by resection of tonsillar cancer.
The data were retrospectively summarized from 10 patients with recurrent tonsillar cancer after radical radiotherapy from January 1998 to December 2005, including 7 cases of squamous cell carcinoma, 2 cases of undifferentiated carcinoma, and 1 case of adenoid cystic carcinoma. There were 8 males and 2 females, aged 43-68 years with an average of 58 years. All cases were classified as stages III and IV before radiotherapy according to staging standard of oropharyngeal cancer (International Union Against Cancer, 1997). The time of relapse was 6-32 months after radiotherapy. Recurrent tonsil cancer invaded tongue base, soft palate, posterior wall of pharyngeal, parapharyngeal space, and palate. Tumor size was from 4 cm x 2 cm to 8 cm x 5 cm. Seven cases were accompanied by lymph node metastasis. After carcinoma were completely resected and defects were reconstructed by pectoralis major myocutaneous flap of 7 cm x 5 cm-12 cm x 9 cm. The donor sites were sutured directly.
After operation, pectoralis major myocutaneous flap completely survived in 9 cases. Partial necrosis of pectoralis major myocutaneous flap was found in 1 case; after treatment, the necrotic flap remained small pharyngeal defect. Incision at donor site healed by first intention in 10 cases. All patients showed satisfactory functions of respiratory, voice, and swallowing with no complication. Ten patients were followed up 2 years to 5 years and 8 months. The 3-year survival rate was 66.7% (6/9), and the 5-year survival rate was 20.0% (1/5).
Pectoralis major muscle flap has a high survival rate, which is safe, reliable, easy-to-operate, and can repair larger defect. Pectoralis major myocutaneous flap is an ideal material in repair of defect caused by resection of recurrent tonsillar carcinoma after radiotherapy.
探讨和评价胸大肌肌皮瓣修复扁桃体癌切除术后缺损的效果及优势。
回顾性总结1998年1月至2005年12月10例根治性放疗后复发性扁桃体癌患者的资料，其中鳞状细胞癌7例，未分化癌2例，腺样囊性癌1例。男8例，女2例，年龄43～68岁，平均58岁。所有病例放疗前按口咽癌分期标准（国际抗癌联盟，1997年）均为Ⅲ、Ⅳ期。复发时间为放疗后6～32个月。复发性扁桃体癌侵犯舌根、软腭、咽后壁、咽旁间隙及腭部。肿瘤大小为4 cm×2 cm至8 cm×5 cm。7例伴有淋巴结转移。癌肿完整切除后，用7 cm×5 cm～12 cm×9 cm的胸大肌肌皮瓣修复缺损，供区直接缝合。
术后9例胸大肌肌皮瓣完全成活，1例胸大肌肌皮瓣部分坏死，经处理后坏死皮瓣遗留小的咽缺损。供区切口10例均一期愈合。所有患者呼吸、发声及吞咽功能均满意，无并发症。10例患者随访2年至5年8个月，3年生存率为66.7%（6/9），5年生存率为20.0%（1/5）。
胸大肌肌瓣成活率高，安全可靠，操作简便，能修复较大缺损。胸大肌肌皮瓣是修复放疗后复发性扁桃体癌切除术后缺损的理想材料。
