Using More than One Flap to Reconstruct the Composite Defect Simultaneously after Advanced Oral Cancer Ablation Surgery-Mackay Memorial Hospital Experience

嚴重侵犯的口腔癌病人進行切除手術後同時使用多個自由皮瓣重建－馬偕紀念醫院病例分析

吳孟穎(Meng-Ying Wu) ； 蕭弘道(Hung-Tao Hsiao) ； 董光義(Kwang-Yi Tung)

《中華民國整形外科醫學會雜誌》 18卷3期 (2009/09) Pp. 231-239

https://doi.org/10.7096/JPSA.200909.0231

摘要

背景：
口腔癌的發生率近年來一路攀升位居男性癌症的第四位，同時臨床上嚴重侵犯的腫瘤越來越常見。口腔癌的治療以手術切除再加上輔助性放射化學治療為主。對於這些嚴重侵犯的腫瘤，過去為了保留較多組織與功能而選擇較保守放射化學治療，但是存活率不佳。文獻證實手術切除腫瘤同時帶有一定的安全範圍能有較高的存活率。隨著顯微重建手術的進步，這些腫瘤嚴重侵犯的病人在手術時切除大量組織器官而形成大範圍的缺損時可以同時進行多個自由皮瓣來重建。這類的手術相對困難許多。
目標及主旨：
本研究目的在回溯分析馬偕紀念醫院對於嚴重侵犯的口腔癌病人接受切除手術後進行複雜重建的經驗。
材料及方法：
從2002年1月到2008年10月，一共有44個病人接受這類複雜的重建手術。其中有42人使用兩個自由皮瓣重建，另外兩人接受三個自由皮瓣重建。手術的方式及分析討論在內文中有詳盡的說明。
結果：
總共有九十個自由皮瓣被用來重建，手術成功率達百分之九十。皮瓣的選擇是依據腫瘤切除後缺損的組織來決定。同側頭頸部的血管是吻合的首選，若同側無適當的血管提供吻合時，對側的血管就會被考慮使用。所有的血管都不適用的情況下，旁接在頸動脈的方式也被使用，但是需注意觀察病人考神經的併發症。
結論：
當重建手術能夠提供足夠的支援時，耳鼻喉科醫師或口腔外科醫師在進行切除手術時就能廣泛的切除腫瘤。我們再選擇適當的組織皮瓣來進行重建。如此一來不但腫瘤能夠切除的乾淨，同時能夠達到外觀及功能的重建。病人因此而能夠得到較佳的存活率以及功能和外觀。

並列摘要

Background:
The incidence rate of oral cavity cancers is rising in Taiwan and cases with locally advanced disease are increasingly common in our clinical experience. Aggressive surgery for advanced oral cancers followed with adjuvant therapy can offer reasonable survival. After radical ablative procedure, more then one flap to reconstruct the complex defect is usually required.
Aim and Objectives: The purpose of this study was to review our experience of complex flap reconstruction at our hospital.
Materials and Methods:
From January 2002 to October 2008, 42 patients receiving two-free flap and, 2 patients received 3-free flap reconstruction simultaneously after primary resection of oral cancer were included in our study. The tumor location, donor site selection, recipient vessels, and complications were analyzed.
Results:
Total 90 flaps were harvested in this series. The complete flap survival rate was 90%. The flaps used for reconstruction included osteocutaneous flaps, fasciocutaneous flaps, myocutaneous flaps, and jejunum flaps. Selection of flap wass based on the defect characteristics after resection. The most common recipient vessels were in the neck dissection area. The use of contralateral vessels was occasionally necessary. The carotid artery end-to-side anastomosis was performed in selective patient, who had no suitable recipients in the neck area.
Conclusion:
In patients with advanced oral cancer, reconstruction usually necessitates multiple flaps. With elaborate reconstructive techniques, aggressive ablation surgery is justified to achieve free surgical margins and to improve clinical outcomes.

並列關鍵字

oral cancer ； flap reconstruction ； end-to-side anastomosis to carotid artery ； microsurgery