【作者】 潘朝斌； 黄洪章； 李劲松； 赵小朋； 张彬； 王建广； 杨朝晖；

【Author】 PAN Chao-bin,HUANG Hong-zhang,LI Jin-song,ZHAO Xiao-peng, ZHANG Bin,WANG Jian-guang,YANG Zhao-hui. (Department of Oral and Maxillo-facial Surgery,The Second Affiliated Hospital,Sun Yat-sen University,Guangzhou 510120,China)

【机构】 中山大学附属第二医院口腔颌面外科；

【摘要】 目的:探讨应用带肋胸膜的肋骨-胸大肌复合瓣联合修复晚期口腔癌根治术后口腔软硬组织大型缺损的临床效果和安全性。方法:从2004年2月至2009年3月,对20例累及同侧口底和下颌骨并越过中线的晚期舌癌或牙龈癌患者实施舌颌颈联合根治术,同期开胸切取带肋胸膜的肋骨(第5肋)-胸大肌复合瓣即刻修复根治术导致的舌、口底和下颌骨大型组织缺损。胸大肌肌皮瓣用以重建舌和口底,肋骨瓣用以修复患侧下颌骨。结果:20例患者均安全、平稳度过围术期。肋骨-胸大肌复合瓣全部成活,术后口腔、颈部和胸部创面均一期愈合。重建舌、口底和面下部形态良好,上下颌咬合关系正常,下颌骨无偏斜,颞下颌关节功能正常。结论:带肋胸膜的肋骨-胸大肌复合瓣修复口腔颌面大型软硬组织缺损安全可靠,开胸切取肋胸膜不会导致患者术后胸廓运动和呼吸功能异常及其它胸肺部并发症,而且制备简便,带肋胸膜确保了肋骨-胸(?)肌复合瓣中肋骨的血运。本方法值得推广应用。更多还原

【Abstract】 Objective:explore the clinical value and safety of using rib-major pectoralis myocutaneous flap carrying costal parietal pleura in combined repair of large soft and hard tissue defect caused by radical surgery of advanced cancer in oral and maxillo-facial region.Methods:From February 2004 to March 2009,20 patients with advanced tongue carcinoma or gingival carcinoma involving the floor of mouth and mandible were performed combined radical neck dissection with glossectomy and mandibulectomy,which caused large soft and hard tissue defect.Six rib-major pectoralis myocutaneous flaps carrying costal parietal pleura were transferred for immediate repair of the large defects.The rib flaps were applied for the repair of mandible,and the major pectoralis myocutaneous flaps were applied for the reconstruction of tongue and floor of mouth.Results:20 patients tided over perioperation safely.There were no pneumothorax and pneumonia after operation.20 rib-major pectoralis myocutaneous flaps carrying costal parietal pleura survived well,and the wounds of surgical incision of the oral cavity,neck,and chest healed up.The reconstructed tongue and the lower face appearance were satisfactory,and the occlusion relationships were normal,and the speaking as well as swallowing functions recovered.Conclusion:It’s safe and reliable to use rib-major pectoralis myocutaneous flap carrying costal parietal pleura to repair large soft and hard tissue defect in oral and maxillo-facial region.Opening pleural cavity and harvest costal parietal pleura would not inference patients’ thoracic movement and breath function and would not cause other complications.It’s simple and safe for harvesting the complex flap.Carrying costal parietal pleura assures the sufficient blood supply of rib in the complex flap.The technique is worthwhile to popularize and apply.更多还原