整形外科在肿瘤多学科治疗中的作用

Peirong Yu

肿瘤患者的多学科治疗需要很多专家紧密的团队配合才能实现。任何获得成功的肿瘤治疗案例，首先需要的就是建立一个专业的团队。对于许多晚期的实质性器官肿瘤，外科扩大切除必须用到皮瓣重建技术。复杂的器官重建不但需要专业知识和技能，同时也需要足够的奉献精神。治疗这些病例往往耗时长、报酬低，并且有时风险很高。有时即便外科医师的手再巧，并发症也往往难以避免，尤其在解剖部位接近重要器官的时候。然而，成功的修复重建对患者有很大益处，因为他们可能在术后无瘤状态下存活很长时间，要有很高的生活质量。在外科手术前，必须向患者及其家属详细解释可能出现的并发症，让他们理解将来可能发生什么。一些伴有致命性并发症的患者在他们被告知会死在家中后仍会选择来到我们这里，请求手术治疗。外科手术不但能拯救他们的生命，还能保存他们器官的功能让他们过上基本正常的生活。只有通过不懈努力、奉献以及创新，我们才能在这个领域中不断前进。

Fig.10 A large 3-dimentional defect in the mid-face following radical resection of a recurrent cancer with exposed dura repair, missing nasal sidewall and palate, as well as cheek skin (a). A multi-island anterolateral thigh flap was used to reconstruct all three surfaces (b-d) and a segment of the vastus lateralis muscle to cover the craniobase.

Fig.14 A hemiglossectomy defect (a) was reconstructed with a thin radial forearm free flap (b). The remaining tongue was able to move the flap around to function (c).

Fig.22 A patient with recurrent thyroid cancer with tracheal destruction (a). Surgical resection created a 6.5 cm long tracheal defect (b) which was reconstructed with a radial forearm free flap supported with an aorta graft and Polymax mesh (c and d). The patient recovered with no complications and a one-year follow-up photograph is shown (e). She has normal voice and consumes a regular diet. One-year follow-up CT scan showed patent airway (f).

Fig.31 Another sarcoma patient required resection of the clavicle, sternum, ribs, and the subclavian artery and vein with exposed lungs and brachial plexus (a). The subclavian artery was reconstructed with a Gortex vascular graft (b). The chest wall defect was reconstructed with a free anterolateral thigh flap with the vastus lateralis muscle(c).