咽頭下癌術後欠損部の再建における異種遺伝子細胞性皮膚マトリックスと皮膚移植の比較。レトロスペクティブコホート研究

Comparison of xenogeneic acellular dermal matrix and skin grafts in reconstruction of postoperative defects of hypopharyngeal cancer: A retrospective cohort study.

• Jian Zang
• Shuai Feng
• Huijun Yang
• Xing Guo

抄録

腫瘍切除後の再建を成功させることは、迅速な回復と良好なQOLの保持を促進し、手術を成功させるために重要である。本研究では、異種細胞性皮膚マトリックス（xeno-ADM）と腹部皮膚グラフトを用いた咽頭下咽頭再建術の適用と有効性を解析し、比較検討することを目的とした。患者は使用した修復材料により2群に分けられた。11例にはxeno-ADMを、14例には下咽頭粘膜欠損の修復に腹部皮膚移植を行った。2群の術中データ、術後の摂食機能回復時間、グラフト収縮、感染症・咽頭瘻孔率、1年生存率を解析し、比較した。皮膚移植群（23.1日）と比較して、xeno-ADM群の摂食機能回復時間は17.3日（17.3日）、（P"Zs_200A"="Zs_200A".026）と短かった。また、術後の入院日数は、皮膚移植群(24.1日)に比べ、xeno-ADM群(18.5日)では6.7日と少なかった(P"Zs_200A"±"Zs_200A"5.6日) (P"Zs_200A"="Zs_200A".035)。また、2群間の他の比較においても有意差は認められなかった。また、両群ともに明らかな拒絶反応や重度のグラフト収縮は認められませんでした。xeno-ADMと腹部皮膚グラフトはいずれも良好な効果を示したが、xeno-ADMの方が摂食機能の回復が早く、これは上皮化が早いためと考えられる。また、ドナー部位の外傷を避けることができます。

Successful reconstruction after tumor resection facilitates rapid recovery and retention of good quality of life, and this is important for a successful operation. This study aimed to analyze and compare the application and efficacy of xenogeneic acellular dermal matrix (xeno-ADM) and abdominal skin graft in hypopharynx reconstruction.This is a retrospective cohort study that included 25 patients with posterior hypopharyngeal wall cancer who underwent partial hypopharyngectomy with laryngeal preservation. The patients were divided into 2 groups according to the repair materials used. Eleven patients were treated with xeno-ADM, and 14 patients with abdominal skin grafts for repairing hypopharyngeal mucosal defects. The intraoperative data, postoperative recovery time of eating function, graft contraction, infection and pharyngeal fistula rate, and 1-year survival rate of the 2 groups were analyzed and compared.Compared with skin grafts group (23.1 ± 5.8 days), the recovery time of eating function in xeno-ADM group was shorter (17.3 ± 6.4 days), (P = .026). Also the number of postoperative hospitalization days were less in the xeno-ADM group (18.5 ± 6.7 days) than in the skin grafts group (24.1 ± 5.6 days) (P = .035). Besides, no significant differences were observed in other comparisons between the 2 groups. Also no obvious rejection and severe graft contraction were observed in both the groups. All patients were successfully decannulated.Both xeno-ADM and abdominal skin grafts demonstrated good effects in the reconstruction of hypopharynx, but the recovery time of eating function in patients with xeno-ADM was faster, which may be due to rapid epithelialization. In addition, it avoids trauma of donor sites.