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題名 | Experiences with Free-tissue Transfer in Head and Neck Cancer Patients Having Coronary Artery Disease=頭頸部癌患者同時合併冠狀動脈疾病接受自由皮瓣移植的經驗分享 |
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作者 | 陳彥州; 楊家森; 謝青華; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 21:2 2012.06[民101.06] |
頁次 | 頁99-106 |
分類號 | 416.413 |
關鍵詞 | 頭頸部癌; 冠狀動脈疾病; 自由皮瓣移植; Head and neck resection; Free tissue transfer; Coronary artery disease; |
語文 | 英文(English) |
中文摘要 | 背景:目前頭頸部癌接受手術切除後最主要的重建方式為顯微自由皮瓣移植,雖然已有許多文獻證實顯微自由皮瓣在老人以及併發疾病的安全性即可靠性,但是實行顯微皮瓣於頭頸部腫瘤病人合併有冠狀動脈疾病的結果卻很少提及。目的及目標:分享我們處理頭頸部腫瘤病人合併有冠狀動脈疾病接受顯微自由皮辦的經驗。材料及方法:從2006年至2010年五年的期間,總共952個案例於高雄長庚紀念醫院接受頭頸部腫瘤切除及顯微皮瓣重建手術。我們從這些案例中挑出合併有冠狀動脈疾病的病人記錄及分析他們的基本資料,腫瘤相關資料,用藥,手術資料結果以及術後併發症。結果:總共有14個病人包含進這個研究接受了總共15各顯微皮瓣移植(12個前大腿外側皮辦,3個腓骨皮瓣),所有的皮辦皆存活,有一個腓骨皮辦有局部壞死。但是有兩個病人因術後心肌梗塞及肺炎而死亡,死亡率為14.3%。結論:在頭頸部腫瘤合併有冠狀動脈疾病的病人實行顯微皮瓣移植是可行的,但是即使在非常嚴格的術前及術後照顧之下,這些病人還是可能因為心臟及肺部的併發症而死亡,強烈建議在手術之前必須要非常詳細的跟病人以及家屬解釋術後因併發症無預期死亡的可能性。 |
英文摘要 | Background:Microvascular free tissue transfer to head and neck defect after tumor ablation is the main method in current practice. Although the safety and reliability was proven in high risk patients such as elderly or patients with concomitant medical comorbidities, the outcome of performing such major operation in patients with coronary artery disease is rarely reported.Aim and Objectives:To share our experience in treating head and neck cancer patients who had coronary artery disease and received tumor resection as well as free flap reconstruction regarding the management and the outcome.Materials and methods:Retrospective review of 952 patients undergoing extensive surgical resections and free flap reconstruction in a 5-year period was performed from 2006 to 2010. Patients with coronary artery disease were identified and their demographic, medications, surgery and tumor related data as well as postoperative surgical and medical complications were recorded and analyzed from prospective maintained database.Results:14 patients with coronary artery disease were identified. 15 free flap procedures (12 anterolateral thigh flaps, 3 fibula flaps) were performed. All flaps survived. Partial skin paddle loss was observed in a fibula flap. There were 2 patients died because acute myocardial infarction and pneumonia respectively. The mortality rate was 14.3%. Conclusion:To perform microvascular free tissue transfer for head and neck reconstruction in patients with coronary artery disease is feasible. However, postoperative cardiac or pulmonary complications may result in mortality despite strict preoperative and postoperative management. A thorough discussion to patient and family with emphasis on unexpectable postoperative death before operation is strongly advised. |
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