【摘要】 目的探讨脱细胞真皮基质黏膜组织补片(acellular dermal matrix,ADM)在咽部的修复作用。方法2003年6月—2004年12月对18例患者行口咽、喉咽癌切除术,其中4例肿瘤原发于口咽和喉咽后壁,保留喉功能切除肿瘤,用ADM重建口咽和喉咽后壁;3例肿瘤原发一侧梨状窝侧壁和咽后壁,声带活动正常的,保留喉功能行咽后壁或侧壁切除术,将ADM缝在椎前筋膜和咽侧壁上关闭咽腔,用保留的胸锁乳突肌加固;对11例肿瘤累及颈段食管,声带活动受限及固定者,行喉全切除或喉咽全切除术,将ADM缝在椎前筋膜上重建喉咽后壁,用胸大肌肌皮瓣重建喉咽前壁和侧壁,重建密闭腔道。术后全部患者进行放射治疗,放疗剂量60~70Gy。结果18例患者术后未发生排异反应,无咽瘘,创面均黏膜化。2例患者切口皮下感染,经换药后伤口愈合。所有患者均可经口进食。7例保留喉的患者恢复了喉功能,拔除气管套管,但其中3例进食流质时有轻度误咽。术后随访12~30个月,中位随访时间为19·38个月,补片移植区无排异反应、瘢痕和挛缩。随访18月以上11例,其中3例肿瘤复发,1例再次手术后健在,2例死于全身转移。结论ADM来源方便,组织相容性好,厚薄适宜,手术操作简便,可联合胸大肌肌皮瓣或其他颈部组织修复咽部环周缺损,是一种新的安全有效的修复材料。更多还原

【Abstract】 Objective To evaluate the clinical use of acellular dermal matrix (ADM) in the repair of pharynx. Method From June 2003 to December 2004, 18 cases of laryngopharyngeal carcinoma or oropharyngeal carcinoma accepted treatment of surgery. Four of them had the tumor in the place of posterior wall of laryngopharynx or oropharynx. In the operation, the tumor was resected and the function of larynx was reserved, reconstruction of the posterior wall of laryngopharynx or oropharynx was made with ADM. Three of them had normal function of vocal cords and the tumor was in the place of posterior wall of pharynx and lateral wall of piriform fossa. These patients accepted resection of the tumor and the larynx was reserved. ADM was sutured to the prevertebral fascia to repair the pharynx, reinforcement was made with sternocleidomastoid muscle then. The other 11 patients had the tumor in the pharynx and cervico-esophagus and the vocal cords were fixed. These cases accepted total resection of the larynx and laryngopharynx. ADM was sutured to the prevertebral fascia to repair the posterior wall of laryngopharynx, musculo-cutaneous flap of pectoralis major muscle was made to repair the anterior and lateral walls. All these 18 patients accepted radiotherapy after the operation, the dosage was 60- 70 Gy. Results Among all these 18 cases, no rejection of ADM or formation of pharynx fistula happened after the operation. The allograft became normal mucosa finally. Two patients had subcutaneous infection. After the treatment of dressing change and antibiotics, the wound healing was satisfying. All the 18 patients had resumption of oral diet finally but 3 of them had light mis-swallowing. Seven patients whose larynx were reserved had the trachea cannula pulled out. The follow-up periods after the operation lasted 12 months to 30 months. The middle follow-up period was 19.38 months. Neither rejection nor scar formation of the allograft happened. The follow-up of 11 patients lasted more than 18 months, 3 of them had relapse of tumor. After the second operation 1 patient was still alive and 2 patients died of distant metastasis. Conclusion ADM can be easily obtained. Its histocompatibility were perfect. The operative procedure were easy to perform. The complications of donor part can be totally avoided. The combined use of ADM and musculo-cutaneous flap of pectoralis major muscle or other neck tissue was safe and effective in the reconstruction of pharynx.更多还原