颈部放射性溃疡的治疗(1)
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[摘要]目的：探讨颈部放射性溃疡的手术方法。方法：彻底或姑息性切除颈部放射性溃疡组织后，根据颈部组织损伤程度的不同，分别用同侧胸三角皮瓣或胸大肌肌皮瓣进行颈部缺损的修复，供区使用全厚皮片修复。结果：11例胸三角皮瓣、3例胸大肌肌皮瓣全部成活，愈合良好，术后患者生活质量明显改善。结论：胸三角皮瓣与胸大肌肌皮瓣血运可靠，是修复颈部放射性溃疡的有效、简单和安全的方法。
[关键词]颈部；放射性溃疡
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2012)05-0710-04
The therapy on radiation ulcer of the neck of the body
JIN Zeng-qiang1,LIN Ai-qin2,ZHANG Rui-ping3,MA Xiao1,YANG Wen-feng1,YANG Zhi-xiang1
(1.The 307th Hospital Affilicated to Academy of Military Medical Sciences,Department of Plastic Surgery,Beijing 100071;2.Zhengzhou Railway Occupational and Technological Institute;3.The 306th Hospital of the Chinese People's Liberation Army)
Abstract: Objective To explore the methods of clinical therapy on radiation ulcer of the neck of the body. Methods According to the difference of injured degree, using tautomeral delto-pectoral shin flap or pectoralis major myocutaneous flap to repair the defect of neck respectively after removing the tissue of radiationg ulcer of the neck thoroughly or palliatively, and using full-thickness skin graft to repair donor site. Results The 11 cases of delto-pectoral shin flap and the 3 cases of pectoralis major myocutaneous flap were all survived successfully, and were healed well with the wound surface of neck. The quality of lives of patients were improved obviously after the operation. Conclusion The tautomeral delto-pectoral shin flap and the pectoralis major myocutaneous flap are effective,simple and safe reconstructive option for radiation damage of the neck of the body.
Key words:the neck of the body; radiation ulcer
放疗是治疗鼻咽癌、颈部淋巴结转移癌的有效治疗方法，但由于放疗本身所固有的副作用或应用不当，颈部放疗常导致颈部肌肉、血管、神经等重要组织结构的损伤，甚至局部形成较大的、难以自行愈合的溃疡，严重影响了患者颈部的正常运动及吞咽活动，甚至可导致患者颈部大血管的破裂而使患者出现死亡。自2007年以来，笔者应用胸三角皮瓣和胸大肌肌皮瓣修复颈部放射性溃疡14例，取得了良好的效果。
1 资料和方法
1.1 临床资料：本组患者共14例。男性12例，女性2例；年龄54～68岁。因鼻咽癌放疗导致的颈部放射性损伤4例，因颈部淋巴结转移癌放疗所致的放射性损伤10例；14例中因放疗导致颈部组织纤维化、颈部运动障碍，局部形成浅表性溃疡的患者11例，形成深达颈鞘及其深部的放射性溃疡3例，有明显臂丛神经损伤症状的患者3例。溃疡最大11cm×10cm，最小3cm×3cm，溃疡表面多有黄白色坏死物质，触之易出血。
1.2 方法
1.2.1术前处理：所有患者术前给予溃疡部位换药处理，3例患者因局部伤口感染严重，先行局部清创、VSD(vacuum sealing drainage)负压吸引，以减轻局部炎症，促进伤口内肉芽组织生长，然后进行皮瓣修复；术前均给予抗生素防治感染治疗(术前伤口内分泌物做细菌培养+药物敏感实验，发现伤口内细菌多为金黄色葡萄球菌，个别病例伤口内检出绿脓杆菌，故根据药敏结果选用抗生素进行全身抗感染治疗，抗生素使用时间一般为术前5～7天) ......
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