带蒂胸大肌肌皮瓣保护颈动脉成功挽救性手术治疗BNCT诱发的下咽瘘

文献信息

中文摘要

硼中子俘获治疗（BNCT）是局部晚期或复发性头颈癌的一种新兴治疗方法，但可能发生严重的晚期并发症，包括咽瘘和颈动脉破裂。我们报告一例71岁男性，因下咽鳞状细胞癌接受BNCT后出现下咽瘘，距颈总动脉2毫米。进行性坏死导致颈动脉暴露和破裂风险高，促使紧急挽救性手术。清创后，遗留15×20毫米的全层咽壁缺损，邻近颈动脉。将带蒂胸大肌肌皮瓣包裹颈动脉进行环形保护，并将黏膜边缘缝合至肌体以闭合瘘口。暴露的肌肉表面随后上皮化。经过吞咽康复后恢复经口进食，术后9个月无瘘复发、手术部位并发症或肿瘤复发。在精心选择的病例中，对于适合二次上皮化的局限性缺损且颈动脉破裂风险高的情况，带蒂肌皮瓣可能是颈动脉保护和瘘口闭合的一种有用的重建选择。

英文摘要

Boron Neutron Capture Therapy (BNCT) is an emerging treatment for locally advanced or recurrent head and neck cancer, but severe late complications, including pharyngeal fistula and carotid blowout, may occur. We report a 71-year-old man with a hypopharyngeal fistula 2 mm from the common carotid artery after BNCT for hypopharyngeal squamous cell carcinoma. Progressive necrosis posed a high risk of carotid exposure and rupture, prompting urgent salvage surgery. After debridement, a 15 × 20 mm full-thickness pharyngeal wall defect remained adjacent to the carotid artery. A pedicled pectoralis major muscle flap was wrapped around the carotid artery for circumferential protection, and the mucosal edge was sutured to the muscle body to close the fistula. The exposed muscle surface subsequently epithelialized. Oral intake was resumed after swallowing rehabilitation, with no fistula recurrence, surgical-site complications, or tumor recurrence by postoperative month 9. In carefully selected cases with a localized defect suitable for secondary epithelialization and high risk of carotid blowout, a pedicled muscle flap may represent a useful reconstructive option for carotid protection and fistula closure.