胸大肌肌皮瓣修复下咽癌术后缺损的临床疗效分析

Clinical Efficacy Analysis of Pectoralis Major Myocutaneous Flap for Repairing Postoperative Defects of Hypopharyngeal Cancer

摘要: 目的：探讨带蒂岛状胸大肌肌皮瓣在保留喉功能的下咽癌切除术后缺损修复中的应用价值。方法：回顾性分析2024年1月至2025年12月我院收治的6例下咽癌患者的临床资料。所有患者均行肿瘤扩大切除术，并在保留喉功能的前提下，采用同侧带蒂岛状胸大肌肌皮瓣进行一期缺损修复。观察皮瓣成活情况、术后并发症、喉功能恢复情况及患者满意度。结果：6例患者肌皮瓣全部成活，术后1例发生咽瘘，经局部换药后愈合。所有患者术后1~3个月内成功拔除气管套管，恢复经口进食及发声功能。术后随访3~12个月，患者对外形及功能恢复均表示满意。结论：带蒂岛状胸大肌肌皮瓣是修复下咽癌术后缺损的安全有效方法，在保留喉功能的前提下可实现良好的功能重建，值得临床推广应用。

Abstract: Objective: To investigate the clinical value of the pedicled island pectoralis major myocutaneous flap in defect reconstruction following larynx-preserving hypopharyngeal carcinoma resection. Methods: Clinical data of 6 patients with hypopharyngeal carcinoma treated at our hospital from January 2024 to December 2025 were retrospectively analyzed. All patients underwent extended tumor resection and primary defect reconstruction using ipsilateral pedicled island pectoralis major myocutaneous flaps while preserving laryngeal function. Outcomes assessed included flap survival, postoperative complications, laryngeal function recovery, and patient satisfaction. Results: All myocutaneous flaps survived in the 6 patients. One postoperative case developed a pharyngeal fistula, which healed after local wound care. All patients successfully had their tracheostomy tubes removed within 1~3 months postoperatively, regaining oral feeding and vocal function. At follow-up (3~12 months), patients reported satisfaction with both cosmetic and functional outcomes. Conclusion: The pedicled island pectoralis major myocutaneous flap represents a safe and effective method for reconstructing hypopharyngeal cancer defects. It achieves favorable functional restoration while preserving laryngeal function, warranting clinical application.