以肌肉瓣應用於頭頸部手術之咽部缺損重建

Muscular Flap for the Reconstruction of Pharyngeal Defect in Head and Neck Surgery

朱本元(Pen-Yuan Chu) ； 張學逸(Shyue-Yih Chang)

《中華民國耳鼻喉科醫學會雜誌》 33卷2期 (1998/04) Pp. 132-138

https://doi.org/10.6286/1998.33.2.132

摘要

背景：頭頸部癌是國人常見的癌症之一，由於腫瘤生長的位置常處於咽部或靠近咽部的組織，所以在進行徹底手術切除時，往往會造成較大的咽部缺損，導致機能的障礙及頸動脈的暴露，而需要同時施行重建手術。基本上，咽部缺損的重建需考慮到所取用組織瓣的方便性、可靠性及機能的恢復等因素。
方法：自1984年至1996年，共44例頭頸部碰症病患經徹底手術切除後，以肌肉瓣做咽部缺損之重建，其中27例以嚼肌肌肉瓣(masseter muscular flap)重建，15例以胸大肌肌肉瓣(pectoralis major muscular flap)重建，2例以胸鎖乳突肌肌肉瓣(sternocleidomastoid muscular flap)重建。
結果：以肌肉瓣做為咽部缺損之重建，因沒有附帶表皮而不需特殊設計形狀，取用時較為方便；同時因不含皮下脂肪，所以大小適中、可摺疊配合各種缺損，縫合時也較為容易。手術後併發症並不常發生，僅1例因肌肉瓣部份壞死而產生咽皮瘻管，3例產生傷口感染；術後的機能恢復亦相當理想。
結論：以肌肉瓣做為頭頸部癌症手術後咽部缺損之重建，是一種簡單、方便、可靠的方法，不僅縫合容易而且可以減少併發症的產生，同時又有相當理想的機能恢復。(中耳醫誌 1998;33:132-138。)

關鍵字

肌肉瓣 ； 頭頸部重建

並列摘要

Background: Head and neck cancer is one of the most common cancers in Taiwan. Radical surgery and radiotherapy are still the most widely used methods of treatment. The tumor is located at or near-by the pharyngeal area, therefore, surgery will result in a large pharyngeal defect and cause functional deterioration and carotid artery exposure. Thus, reconstruct-tion of the pharyngeal defect plays an important roe in achieving good functional results. Basically, convenience, reliability and functional recovery are the most important factors to be considered n choosing a reconstructive method.
Methods: Between 1984 and 1996, there were 44 cases of head and neck cancer that underwent radical surgery and had the pharyngealdefect reconstructed with a muscular flap. Three different muscular flaps were used includig the masseter muscular flap 27 cases, the pectoralis major muscular flap 15 cases, and the sternocleidomastoid muscular flap 2 cases. Results: Muscular flap reconstruction is a convenient method. It is not necessary to design the flap, because there is no skin over the flap. There is no excessive subcutaneous tissue at the flap, therefore, it has adequater size and is more pliable, and wound closure is easier. Complications are rare. Only 1 case of pharyngocuta-neous fistula occurred due to partial necro-sis of the flap, and 3 cases of wound infec-tion were encountered. Postoperative swal-lowing function was satisfactory.
Conclusions: The muscular flap is a simple, convenient, and reliable method for reconstruction in the major head and neck surgeries. The wound closure is easy, and the complications are rare. In addition, the functional reconvery is satisfactory.

並列關鍵字

muscular flap ； head and neck reconstruction