本文關(guān)鍵詞： 頭頸部缺損 修復(fù) 胸大肌肌皮瓣 重建　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討組織量豐富的胸大肌肌皮瓣在頭頸部腫瘤切除術(shù)后缺損修復(fù)的手術(shù)技巧及術(shù)后并發(fā)癥的處理與預(yù)防。方法篩選2008年1月1日~2014年10月1日期間,于我院耳鼻咽喉頭頸外科行頭頸惡性腫瘤切除術(shù)后使用胸大肌肌皮瓣修復(fù)缺損的部分患者(僅包括超重/肥胖男性患者及女性患者),回顧性總結(jié)相關(guān)手術(shù)技巧及相應(yīng)的術(shù)后并發(fā)癥的處理經(jīng)驗(yàn)。對于超重/肥胖男性或/和女性患者,其胸大肌肌皮瓣組織量豐富,利用改良的方法設(shè)計(jì)制備后,可修復(fù)頭頸部各種缺損。皮島通常設(shè)計(jì)在乳暈內(nèi)下側(cè)的胸大肌表面。皮島皮膚、皮下組織的切面與胸大肌筋膜表面所形成夾角應(yīng)不小于45°;于皮島外側(cè)1cm左右切斷胸大肌內(nèi)側(cè)、下側(cè)及外側(cè)至肋骨骨膜和肋間肌表面,再于其表面向上剝離胸大肌至胸小肌表面;通過透視方法找出胸大肌肌皮瓣的血管蒂;制備好胸大肌肌皮瓣將其拉到缺損處,首先將胸大肌肌皮瓣的肌肉部分固定于術(shù)后缺損處,再將皮膚與受區(qū)的肌肉或粘膜對縫;修復(fù)后胸大肌肌皮瓣周圍潛在的腔隙均需要放置負(fù)壓引流。結(jié)果本研究共23例,其中1例超重/肥胖患者在制備胸大肌肌皮瓣過程中誤傷胸肩峰動脈,術(shù)中改為制備另一側(cè)胸大肌肌皮瓣。制備完好的共23例胸大肌肌皮瓣全部成活,其中只有1例遠(yuǎn)端部分壞死,經(jīng)換藥后二期愈合;共有3例受區(qū)感染,形成咽漏,換藥治療后Ⅱ期愈合;1例患者受區(qū)皮膚與皮瓣部分裂開,同樣經(jīng)換藥處理,Ⅱ期愈合;另有1例患者供區(qū)出現(xiàn)皮下積血,及時清理淤血后愈合。結(jié)論組織量豐富的胸大肌肌皮瓣,不論是超重/肥胖的男性患者還是女性患者,由于血管走向恒定、血供豐富,雖然臃腫,制備和修復(fù)時比較困難,但只要確保手術(shù)中正確定位,細(xì)心識別血管蒂,仔細(xì)操作,術(shù)后積極密切監(jiān)測和護(hù)理皮瓣及時發(fā)現(xiàn)并發(fā)癥,并給予有效處理,肌皮瓣與創(chuàng)面仍可良好愈合,因此該類皮瓣仍然是頭頸部術(shù)后缺損修復(fù)重建的重要皮瓣。
[Abstract]:Objective to explore the surgical techniques and prevention of postoperative complications of pectoralis major myocutaneous flap with abundant tissue in repairing defects after head and neck tumor resection. Methods from January 1st 2008 to October 2014, we selected. During 1st. Partial patients (including overweight / obese male and female) who were treated with pectoralis major myocutaneous flap after resection of malignant tumor of head and neck in our hospital. A retrospective review of the relevant surgical techniques and the corresponding experience in the management of postoperative complications. For overweight / obese male or / and female patients, the pectoralis major myocutaneous flap is abundant, using the improved method of design and preparation. All kinds of defects in head and neck can be repaired. The skin island is usually designed on the surface of pectoralis major muscle on the lower side of the medial areola. The angle between the cut surface of the subcutaneous tissue and the surface of the pectoralis major fascia should not be less than 45 擄in the skin of the skin island. The medial part of pectoralis major muscle was cut off about 1 cm outside of the skin island, and the lower and lateral sides were cut to the surface of the rib periosteum and intercostal muscle, and then the pectoralis major muscle was removed from the surface to the surface of the pectoralis minor muscle. The vascular pedicle of pectoralis major myocutaneous flap was found by fluoroscopy. The pectoralis major myocutaneous flap was prepared to pull it to the defect. First, the muscle part of the pectoralis major myocutaneous flap was fixed to the defect after operation, and then the skin was sutured with the muscle or mucous membrane of the recipient area. Negative pressure drainage was needed in all the potential spaces around the pectoralis major myocutaneous flap. Results in this study, 23 patients were involved in this study, including 1 overweight / obese patient who accidentally injured the pectoralis acromiosus artery during the preparation of the pectoralis major myocutaneous flap. The other pectoralis major myocutaneous flap was prepared during the operation. All of the 23 intact pectoralis major myocutaneous flaps survived, in which only 1 case had partial distal necrosis and healed after dressing change. A total of 3 cases were infected in the recipient area, pharyngeal leakage was formed, and the second stage healed after dressing change. In one case, the skin of the recipient area was partially split from the skin flap, which was also treated by dressing change, and healed in the second stage. Another patient had subcutaneous hemorrhage in the donor area and healed after clearing the blood stasis in time. Conclusion the tissue rich pectoralis major myocutaneous flap, whether in overweight / obese male or female patients, has a constant trend of blood vessels. Although the blood supply is abundant and bloated, it is difficult to prepare and repair, but as long as ensure the correct location in the operation, identify the vascular pedicle carefully, operate carefully, monitor closely after the operation and nursing the skin flap to find the complications in time. The myocutaneous flap can still heal well with the wound, so it is still an important flap to repair and reconstruct the head and neck defect.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.91

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 葛殿奎,汪仁杰,吳煜農(nóng);胸大肌肌皮瓣的改良[J];現(xiàn)代口腔醫(yī)學(xué)雜志;2001年01期

2 葛殿奎,汪仁杰;胸大肌肌皮瓣瓣體部的改良[J];現(xiàn)代口腔醫(yī)學(xué)雜志;2002年02期

3 李雅冬;楊凱;張勁松;張福軍;陳睿;;胸大肌肌皮瓣修復(fù)口腔頜面部軟組織缺損[J];江西醫(yī)學(xué)院學(xué)報(bào);2006年05期

4 耿中利;馬斌林;任光輝;;帶蒂胸大肌肌皮瓣在頭頸部軟組織缺損中的應(yīng)用[J];新疆醫(yī)科大學(xué)學(xué)報(bào);2009年03期

5 青松;熊萬林;尹德輝;楊晶;邱亞;;胸大肌肌皮瓣在晚期舌癌治療中的應(yīng)用[J];四川醫(yī)學(xué);2012年03期

6 嚴(yán)義坪;;帶胸骨旁皮膚蒂的胸大肌皮瓣——胸大肌肌皮瓣的改進(jìn)[J];蘭州醫(yī)學(xué)院學(xué)報(bào);1982年03期

7 洪蘇玲;;胸大肌肌皮瓣的兩點(diǎn)改進(jìn)[J];國外醫(yī)學(xué).耳鼻咽喉科學(xué)分冊;1988年01期

8 ;改良胸大肌肌皮瓣應(yīng)用經(jīng)驗(yàn)[J];國外醫(yī)學(xué).耳鼻咽喉科學(xué)分冊;1994年01期

9 饒磊,鄭俊發(fā);胸大肌肌皮瓣切取術(shù)減少出血的幾項(xiàng)措施[J];廣東牙病防治;1999年04期

10 裴榮,賈書生,孫冀;胸大肌肌皮瓣在Ⅲ、Ⅳ期舌癌術(shù)后缺損修復(fù)中的應(yīng)用[J];黑龍江醫(yī)學(xué);2000年12期

相關(guān)會議論文 前10條

1 鄭有華;張志光;廖貴清;楊小平;曾融生;陳亦陽;;胸大肌肌皮瓣在頭頸部組織缺損修復(fù)中的應(yīng)用[A];2004年中國口腔頜面修復(fù)重建外科學(xué)術(shù)會議論文匯編[C];2004年

2 張圃;孫沫逸;李建虎;雷德林;胡曉光;楊耀武;;女性胸大肌肌皮瓣在口腔頜面腫瘤外科軟組織修復(fù)重建中的應(yīng)用[A];第五次全國口腔頜面—頭頸腫瘤學(xué)術(shù)研討會論文匯編[C];2006年

3 王海潮;柳宏志;張洪才;邱明;胡祥文;董吉富;何成君;王錫明;郝鵬程;;胸大肌肌皮瓣在舌癌切除的臨床應(yīng)用[A];中華口腔醫(yī)學(xué)會成立大會暨第六次全國口腔醫(yī)學(xué)學(xué)術(shù)會議論文匯編[C];1996年

4 馬士];韓躍峰;周蘭柱;王文忠;張明潔;;胸大肌肌皮瓣在氣管造口復(fù)發(fā)癌術(shù)后組織缺損修復(fù)中的應(yīng)用[A];2010全國耳鼻咽喉頭頸外科中青年學(xué)術(shù)會議論文匯編[C];2010年

5 李樹春;徐成鈞;;胸大肌肌皮瓣在復(fù)雜頭頸部重建術(shù)中的應(yīng)用[A];第三屆全國口腔頜面部創(chuàng)傷暨修復(fù)重建學(xué)術(shù)研討會論文匯編[C];2003年

6 郭良;王可敬;趙堅(jiān)強(qiáng);梁忠;;胸大肌肌皮瓣一期修復(fù)口腔頜面腫瘤術(shù)后缺損[A];浙江省抗癌協(xié)會頭頸腫瘤外科專業(yè)委員會成立大會暨第一屆學(xué)術(shù)會議論文匯編[C];2006年

7 趙銘;劉善廷;孟昭忠;;胸大肌肌皮瓣在頭頸部大面積缺損修復(fù)中的應(yīng)用[A];第四屆中國腫瘤學(xué)術(shù)大會暨第五屆海峽兩岸腫瘤學(xué)術(shù)會議論文集[C];2006年

8 王月紅;唐瞻貴;尹乒;方小丹;全宏志;趙麗莉;盧若煌;;全舌再造兩種皮瓣修復(fù)方法體會[A];第八次全國口腔頜面—頭頸腫瘤會議論文匯編[C];2009年

9 郭良;;胸大肌肌皮瓣用于咽喉晚期腫瘤術(shù)后一期修復(fù)[A];浙江省抗癌協(xié)會頭頸腫瘤外科專業(yè)委員會成立大會暨第一屆學(xué)術(shù)會議論文匯編[C];2006年

10 廖貴清;蘇宇雄;楊小平;曾融生;張志光;徐英;;胸大肌肌皮瓣脂肪液化的相關(guān)危險因素探討[A];第五次全國口腔頜面—頭頸腫瘤學(xué)術(shù)研討會論文匯編[C];2006年

相關(guān)碩士學(xué)位論文 前3條

1 李永平;胸大肌肌皮瓣在舌再造中的應(yīng)用研究[D];山東大學(xué);2015年

2 劉義森;下咽癌術(shù)后缺損修復(fù)的選擇[D];安徽醫(yī)科大學(xué);2014年

3 田春輝;胸大肌肌皮瓣壞死原因分析及預(yù)防處理體會[D];安徽醫(yī)科大學(xué);2015年

，

本文編號：1475809