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目的探讨游离胸肩峰动脉穿支皮瓣修复舌癌术后缺损的疗效。方法2010年5月—2015年2月,采用游离胸肩峰动脉穿支皮瓣移植修复11例舌癌术后缺损并行舌再造。男9例,女2例;年龄33~72岁,平均52.6岁。均为鳞状细胞癌;原发舌缘7例,原发舌腹2例,口底癌累及舌2例。根据国际抗癌联盟(UICC)TNM分期:T4N0M03例,T4N l M03例,T3N1M02例,T3N2M02例,T3N0M01例。病程3~28个月,平均10.6个月。肿瘤范围6 cm×3 cm~10 cm×5 cm。术中穿支皮瓣切取范围为7.0 cm×4.0 cm~11.0 cm×5.5 cm;厚度0.6~1.2 cm,平均0.8 cm;血管蒂长6.8~9.9 cm,平均7.2 cm。结果术后11例皮瓣均顺利成活,创面Ⅰ期愈合;供区切口均Ⅰ期愈合。患者均获随访,随访时间12~24个月,平均17.2个月。患者再造舌外形良好,吞咽及语言功能满意,随访期间肿瘤局部无复发。供区仅遗留线性瘢痕,胸大肌功能未见明显影响。结论胸肩峰动脉穿支皮瓣质地好,再造舌外形及功能良好,供区损伤小,是舌癌术后舌缺损修复与舌再造的理想选择。
Objective To investigate the curative effect of free thoracoabdominal artery perforator flap in repairing tongue cancer postoperative defect. Methods From May 2010 to February 2015, free flap of the thoracic and arrhythmic artery was used to repair 11 cases of tongue cancer after reconstruction and tongue reconstruction. 9 males and 2 females; aged 33 to 72 years, mean 52.6 years old. All were squamous cell carcinoma; primary tongue margin in 7 cases, primary tongue and stomach in 2 cases, mouth cancer involving the tongue in 2 cases. According to the International Union Against Cancer (UICC) TNM staging: T4N0M03 cases, T4N1 M03 cases, T3N1M02 cases, T3N2M02 cases, T3N0M01 cases. Duration of 3 to 28 months, an average of 10.6 months. Tumor range 6 cm × 3 cm ~ 10 cm × 5 cm. The perforation ranged from 7.0 cm × 4.0 cm to 11.0 cm × 5.5 cm. The thickness ranged from 0.6 cm to 1.2 cm with an average of 0.8 cm. The vessel pedicle length ranged from 6.8 cm to 9.9 cm with an average of 7.2 cm. Results All the flaps of 11 cases survived successfully and the wound healed in the first stage. All the wounds were healed in the first stage. All patients were followed up for 12-24 months with an average of 17.2 months. Patients with re-shaped tongue good shape, swallowing and language function satisfactory, no recurrence of tumor during follow-up. Only for the area left for linear scars, no significant effect on pectoralis major muscle function. Conclusions The perforator flap of the thoracoacromial apex artery is of good texture, good shape and good reformation of the tongue, and less damage to the donor area. It is an ideal choice for repairing tongue defects and rebuilding the tongue after operation.