Chen X F, Lu M, Hong Y M, Zheng C H, Liang Z Y, Li Y Y
Department of Otolaryngology, Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Oct 7;58(10):998-1004. doi: 10.3760/cma.j.cn115330-20230214-00068.
To investigate the clinical application value of coiled tube of femoral anterolateral flap in the repair of circumferential defect after resection of advanced hypopharyngeal carcinoma. Clinical data of 42 patients with advanced hypopharyngeal cancer admitted to the Second Affiliated Hospital of Fujian Medical University from January 2016 to April 2022 were retrospectively analyzed, including 41 males and 1 female, aged from 33 to 82 years old. All patients received surgical treatment, including total laryngectomy plus total laryngopharyngectomy in 20 cases, total laryngectomy, total laryngopharyngectomy and resection of partial tongue base in 8 cases, total laryngectomy, total laryngopharyngectomy and resection of cervical esophagus in 9 cases, total laryngectomy, total laryngopharyngectomy, and resection of partial tongue base and cervical esophagus in 5 cases. The postoperative circumferential defects were repaired with the coil tube of anterolateral femoral skin flap in phase Ⅰ, and the healing status of the flap, wound healing and swallowing function were observed. All cases were followed up. The lengths of the hypopharyngeal defects were 7-18 cm and the sizes of the harvested flaps were 6 cm×9.5 cm-10 cm×20 cm. Flaps survived in 41 cases, flap necrosis occurred in one case, and the survival rate of flaps was 97.6%. One artery and one vein were anastomosed in 40 cases, and one artery and two veins were anastomosed in 2 cases. Postoperative cervical wound infection occurred in 5 cases, and pharyngeal fistula occurred in 2 cases. Three months of follow-up after surgery, 31 cases had normal diet, 9 cases presented with semi-liquid diet and 2 cases with liquid diet. Following up for 6-65 months, recurrence and metastasis occurred in 14 patients (33.3%), including primary site recurrence in 4 cases (9.5%), cervical lymph node recurrence in 6 cases (14.3%), and distant metastasis in 4 cases (9.5%). The 1-year and 3-year overall survival rates were respectively 79.4% and 60.5%. Coiled tube of femoral anterolateral flap is an ideal skin flap for repair of circumferential defects after resection of advanced hypopharyngeal carcinoma.
探讨股前外侧皮瓣卷曲管在晚期下咽癌切除术后环形缺损修复中的临床应用价值。回顾性分析2016年1月至2022年4月福建医科大学附属第二医院收治的42例晚期下咽癌患者的临床资料，其中男41例，女1例，年龄33～82岁。所有患者均接受手术治疗，其中全喉切除加全喉咽切除术20例，全喉切除、全喉咽切除术加部分舌根切除术8例，全喉切除、全喉咽切除术加颈段食管切除术9例，全喉切除、全喉咽切除术加部分舌根及颈段食管切除术5例。术后Ⅰ期采用股前外侧皮瓣卷曲管修复环形缺损，观察皮瓣愈合情况、伤口愈合及吞咽功能。所有病例均进行随访。下咽缺损长度为7～18cm，切取皮瓣大小为6cm×9.5cm～10cm×20cm。皮瓣成活41例，皮瓣坏死1例，皮瓣成活率为97.6%。40例吻合1条动脉和1条静脉，2例吻合1条动脉和2条静脉。术后颈部伤口感染5例，咽瘘2例。术后3个月随访，31例饮食正常，9例进半流食，2例进流食。随访6～65个月，14例（33.3%）出现复发转移，其中原发灶复发4例（9.5%），颈部淋巴结复发6例（14.3%），远处转移4例（9.5%）。1年和3年总生存率分别为79.4%和60.5%。股前外侧皮瓣卷曲管是修复晚期下咽癌切除术后环形缺损的理想皮瓣。
