Zhou Weihua, Li Junliang, Feng Huajun, Xu Shengen, Liu Tianzhen, Wang Dingting, Qin Gang
Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, No.25, Taiping Street, Jiangyang District, Luzhou, 646000, China.
BMC Surg. 2024 Dec 24;24(1):417. doi: 10.1186/s12893-024-02733-4.
To evaluate the efficacy of pedicled supraclavicular flaps in hypopharyngectomy reconstruction, with a focus on preserving laryngeal function.
From August 2019 to June 2022, 14 patients with primary hypopharyngeal carcinoma who met the inclusion and exclusion criteria and underwent the repair of hypopharyngeal defects using pedicled supraclavicular flaps were included retrospectively. Relevant clinical evaluation indicators include patient characteristics, defect sizes, flap sizes, flap harvesting time, postoperative hospital stay, postoperative complications, recurrence, and survival outcomes.
Among the 14 patients, pyriform sinus carcinoma (n = 10) and posterior hypopharyngeal wall carcinoma (n = 4) were present, with stages T2 (n = 7), T3 (n = 4), T4 (n = 3), N0 (n = 3), N1 (n = 1), and N2 (n = 10). The average defect size was 7.0 (4.0-12.6) cm in the longitudinal diameter and 4.1 (2.8-7.5) cm in the transverse diameter. The mean flap size was 8.4 (5.0-14.0) cm in length and 6.5 (4.0-9.0) cm in width. The mean time for flap harvesting was 37.0 (29.0-51.0) min. The mean postoperative hospital stay was 24.0 (12.0-48.0) days. The mean follow-up period was 20.3 (4.0-47.0) months, and one of the 14 patients was lost during follow-up. Short-term postoperative complications included partial flap necrosis (n = 1), subcutaneous hematoma at the donor site (n = 1), and pharyngeal fistula (n = 4). Long-term complications encompassed pharyngoesophageal anastomotic stenosis (n = 2) and shoulder elevation dysfunction (n = 2). Tumor recurrence occurred in 3 patients. 1 patient succumbed to massive hemorrhage resulting from neck infection due to pharyngeal fistula during chemoradiotherapy. 2 patients succumbed to tumor-related causes. The gastric tube was removed in 13 patients, and the tracheal tube was extracted in 10 patients.
The supraclavicular flap offers a promising alternative for reconstruction during hypopharyngectomy with preservation of laryngeal function. It can be utilized to reshape the morphology of the pyriform fossa, aryepiglottic wall, and laryngeal cavity, thereby restoring the functionality of the laryngopharynx.
评估带蒂锁骨上皮瓣在下咽切除术重建中的疗效，重点关注保留喉功能。
回顾性纳入2019年8月至2022年6月期间14例符合纳入和排除标准、采用带蒂锁骨上皮瓣修复下咽缺损的原发性下咽癌患者。相关临床评估指标包括患者特征、缺损大小、皮瓣大小、皮瓣切取时间、术后住院时间、术后并发症、复发情况及生存结局。
14例患者中，梨状窝癌（n = 10）和下咽后壁癌（n = 4），分期为T2（n = 7）、T3（n = 4）、T4（n = 3）、N0（n = 3）、N1（n = 1）、N2（n = 10）。平均缺损纵径为7.0（4.0 - 12.6）cm，横径为4.1（2.8 - 7.5）cm。皮瓣平均长度为8.4（5.0 - 14.0）cm，宽度为6.5（4.0 - 9.0）cm。皮瓣切取平均时间为37.0（29.0 - 51.0）分钟。术后平均住院时间为24.0（12.0 - 48.0）天。平均随访时间为20.3（4.0 - 47.0）个月，14例患者中有1例在随访期间失访。术后短期并发症包括部分皮瓣坏死（n = 1）、供区皮下血肿（n = 1）和咽瘘（n = 4）。长期并发症包括咽食管吻合口狭窄（n = 2）和肩部抬高功能障碍（n = 2）。3例患者出现肿瘤复发。1例患者在放化疗期间因咽瘘导致颈部感染引发大出血死亡。2例患者死于肿瘤相关原因。13例患者拔除胃管，10例患者拔除气管导管。
锁骨上皮瓣为下咽切除术重建并保留喉功能提供了一种有前景的选择。它可用于重塑梨状窝、杓会厌襞和喉腔的形态，从而恢复下咽功能。
