He S Z, Fang J G, Li P D, Zhong Q, Hou L Z, Ma H Z, Feng L, Chen X H, Shi Q
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Dec 7;55(12):1126-1130. doi: 10.3760/cma.j.cn115330-20200701-00546.
To evaluate clinical applications and efficacy of submental artery perforator flap in reconstruction surgery after removal of pharyngeal carcinoma. A total of 27 patients in the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University were included, 23 males and 4 females with age from 40 to 70 years old, and 17 patients were hypopharyngeal carcinoma (HPC) and 10 patients were oropharyngeal carcinoma (OPC). All patients underwent tumor resection followed by simultaneously reconstruction surgery using submental artery perforator flap between January 2015 and December 2019. Of 5 patients with palatine tonsil cancer, 4 underwent the combined approach of neck and oral resection and 1 with madibulotomy. All 5 patients with tongue base cancer received transhyoid partial glossotomy with or without partial laryngectomy. Sixteen patients with pyriform sinus carcinoma received partial laryngo-pharyngectomy with preservation of laryngeal functions. One patient with posterior hypopharyngeal wall carcinoma had partial pharyngectomy. Prognosis and laryngeal functions were analyzed after reconstruction surgery with submental artery perforator flap in patients with pharyngeal carcinoma. The 27 patients were followed up for 6-66 months, with a median of 13 months, of them 24 patients were alive without recurrence or metastasis, 1 patient died of recurrence, 1 patient died of esophageal carcinoma and 1 patient was alive with the recurrence of tongue base carcinoma. Postoperative complications included flap failure for 1 case, pharyngeal fistula for 1 case, subcutaneous hydrops for 2 cases and lymphatic fistula for 1 case. Total 2 and 3 year survival rates were 92.9% and 88.9%, respectively. Total decanulation rate was 92.6%; decanulation rate and intubation time were 16/17 and 3.5 months in HPC patients; and decanulation rate and intubation time were 9/10 and 2 months in OPC patients. Total oral feeding rate was 92.6% and nasogastric feeding time was 3.5 weeks in HPC patients and 3 weeks in OPC patients. The submental artery perforator flap is an excellent choice for reconstruction surgery after removal of oropharyngeal and hypopharyngeal carcinoma, with good outcomes of laryngeal functions.
评估颏下动脉穿支皮瓣在下咽癌切除术后重建手术中的临床应用及疗效。首都医科大学附属北京同仁医院耳鼻咽喉头颈外科共纳入27例患者，其中男性23例，女性4例，年龄40～70岁，下咽癌（HPC）患者17例，口咽癌（OPC）患者10例。2015年1月至2019年12月，所有患者均接受肿瘤切除，同时采用颏下动脉穿支皮瓣进行重建手术。5例腭扁桃体癌患者中，4例行颈部和口腔联合切除术，1例行下颌骨切开术。5例舌根癌患者均接受经舌骨部分舌切除术，部分患者同时行部分喉切除术。16例梨状窝癌患者接受保留喉功能的部分喉咽切除术。1例下咽后壁癌患者行部分咽切除术。分析下咽癌患者采用颏下动脉穿支皮瓣重建手术后的预后及喉功能。27例患者随访6～66个月，中位随访时间为13个月，其中24例患者存活，无复发或转移，1例患者死于复发，1例患者死于食管癌，1例舌根癌复发患者仍存活。术后并发症包括皮瓣坏死1例、咽瘘1例、皮下积液2例、淋巴瘘1例。2年和3年总生存率分别为92.9%和88.9%。总拔管率为92.6%；HPC患者的拔管率和拔管时间分别为16/17和3.5个月；OPC患者的拔管率和拔管时间分别为9/10和2个月。总经口进食率为92.6%，HPC患者鼻饲时间为3.5周，OPC患者为3周。颏下动脉穿支皮瓣是口咽癌和下咽癌切除术后重建手术的理想选择，喉功能恢复良好。
