遊離空腸移植において動脈吻合部血栓を短期間に4回繰り返した1例

Transition to a Pectoralis Major Myocutaneous Flap after Recurrent Arterial Thrombosis in Free Jejunal Transfer for Pharyngolaryngeal Reconstruction: A Case Report

はじめに

　下咽頭喉頭全摘術後の遊離空腸再建における吻合部血栓の頻度は3 ％程度とされている 1）。今回，3回の動脈吻合部血栓後，同一手術中に空腸弁の再挙上および再再建を行ったが，術後に4回目の動脈吻合部血栓を生じ，U字型の有茎大胸筋皮弁移植を用いた再建に切り替えた症例を経験したので提示する。

　Case: A 75-year-old male with advanced hypopharyngeal cancer (SCC cT4aN2bM0 cStage IVA) underwent a total pharyngolaryngectomy and reconstruction with a free jejunal transfer. During the surgery, arterial thrombosis occurred four times, despite multiple attempts at reconstruction. The surgical approach was eventually shifted to a pectoralis major myocutaneous flap, which was sutured in a U-shape to the prevertebral fascia. The patient had no postoperative complications, was able to resume oral intake, and proceeded with postoperative radiotherapy.

　Conclusion: Anastomotic thrombosis, which is influenced by technical and patient factors, could not be definitively traced to a single cause in this patient. This case illustrates the efficacy of promptly resorting to a pedicled flap for salvage surgery when free flap attempts fail.