Clinical Study Of Free Flap In The Defect Repair And Reconstruction After Hypopharyngeal Squamous Cell Carcinoma Operation

Objective:For hypopharyngeal squamous cell carcinoma,the thoroughness of radical resection and the feasibility of repair and reconstruction are the problems that every head and neck surgeon must face.This study mainly introduces the technical points of radial forearm free flap and anterolateral thigh free flap which have been gradually used in clinic in recent years,and discusses the clinical application of radial forearm free flap and anterolateral thigh free flap in the defect repair and functional reconstruction after hypopharyngeal squamous cell carcinoma operation,and evaluates its effect in hypopharyngeal defect repair.Method:Collected 36 cases that took "neck lymph node dissection and hypopharyngeal squamous cell carcinoma resection" in the department of otolaryngology head and neck surgery at the Second Affiliated Hospital of Fujian Medical University from January 2010 to November 2019 for retrospective analysis and follow-up.Considered radial forearm free flap or anterolateral thigh free flap as the free flap repair group,and the rest were local repair group.Among them,15 cases in the free flap repair group(8 cases with radial forearm free flap,7cases with anterolateral thigh free flap),21 cases in local repair group(19 cases with adjacent banded muscle,2 cases with direct contraposition suture of hypopharyngeal mucosa).The laryngeal function of 16 cases were preserved and the laryngeal function of 20 cases were not preserved.33 males and 3 females,46-71 years old,with an average age of 57.08±7.189 years.In accordance with the seventh edition of American Joint Committee on Cancer tumor stage standard: 6cases in stage II,10 cases in stage III and 20 cases in stage IVA.The pathological types were squamous cell carcinoma.Two groups of patients were all in one stage repair of hypopharyngeal defect after hypopharyngeal cancer resection,retrospectively analyzed the postoperative data in patients of the two groups and compared the differences.Followed up patients by outpatient and telephone,the follow-up time is 3 months to 3 years.Collected the information of general situation before operation,primary tumor focus,drainage tube removal time,nasogastric feeding tube removal time,antibiotic use time,recent postoperative complications,hospital days,tracheotomy cannula removal time of patients with preservation of laryngeal function,recurrence rate,condition of speech recovery and other data in patients with laryngeal function reservation,and compared the data of the two groups and carried out statistical analysis.Result:The use of radial forearm free flap and anterolateral thigh free flap to repair hypopharyngeal defect had significant effect on stopping antibiotics(P=0.000)and reducing postoperative recurrence(P=0.041),which was statistically significant compared with local repair group(P<0.05).There was no significant difference between the two groups in other aspects.Conclusion:1.Radial forearm free flap and anterolateral thigh free flap can meet the treatment of most hypopharyngeal defects,which have effect on reducing the postoperative recurrence rate.2.Radial forearm free flap and anterolateral thigh free flap have advantages in stopping antibiotics compared with local repair.3.The operation survival rate of radial forearm free flap and anterolateral thigh free flap is 100% in this study,it is safe to repair hypopharyngeal defect,although there are some complications,the effect is not significant,it can be gradually reduced by strengthening the perioperative management and improving the technical level.