鼻窦癌皮瓣或移植物重建手术的跨学科挑战和目标

在鼻窦癌手术中，一个根本的挑战是了解重建后的术后影像学变化。 对术后影像学的误解可能导致肿瘤复发的误诊。 由于放疗计划是基于影像学，因此在解释术后影像学以正确定义存在皮瓣的情况下放疗肿瘤体积方面存在许多知识空白需要填补。 另一方面，放疗可能导致组织纤维化或萎缩，与单纯手术相比，放疗后重建区域的解剖结构和功能结果可能会发生变化。 这篇叙述性综述阐述了使用皮瓣或移植物进行鼻窦重建手术的跨学科目标和挑战。 在强度调制放射治疗和质子治疗有可能进一步降低发病率的时候，它与放射科医生和放射肿瘤学家特别相关。

鼻窦癌皮瓣或移植物重建手术的跨学科挑战和目标

肠型腺癌经鼻内窥镜去骨瓣切除术后的阔筋膜 (FaLa) 硬膜成形术。 (A) 肿瘤切除后手术视野的内窥镜视图：左右眼眶壁（分别为 RO 和 LO）、蝶窦 (SphS) 和额叶（星号）暴露； 虚线表示硬脑膜切除的范围。 (B) 第一层阔筋膜放置在硬膜内以获得水密闭合。

鼻窦癌皮瓣或移植物重建手术的跨学科挑战和目标

在 T2 加权 MRI 序列上用阔筋膜和腹部脂肪移植物 (B) 对肠型腺癌进行颅底重建的术前 (A) 和术后早期（术后第 5 天）。

鼻窦癌皮瓣或移植物重建手术的跨学科挑战和目标

对比增强 T1 加权 MRI 序列上的鼻中隔皮瓣 (A) 和左侧颞顶筋膜浅筋膜皮瓣 (B) 的术后情况。 注意对比增强后皮瓣的高信号（白色箭头）。

鼻窦癌皮瓣或移植物重建手术的跨学科挑战和目标

复发性鼻咽癌左侧内窥镜鼻咽切除术后，用浅表颞顶筋膜瓣 (sTPFF) 覆盖鼻咽外侧壁。 (A) sTPFF 以颞浅动脉为蒂； 它通过颞/颞下窝隧道（箭头）转移到鼻腔中。 (B) 2 个月后的术后内窥镜视图：皮瓣（虚线）已通过左上颌窦 (PWMS) 后壁的开口引入并覆盖鼻咽侧壁（星号），从而保护 咽旁颈内动脉。

鼻窦癌皮瓣或移植物重建手术的跨学科挑战和目标

对先前受过辐射的患者的嗅神经母细胞瘤进行内窥镜经鼻去骨瓣切除术后，用颅骨膜瓣 (PF) 覆盖前颅底。 (A) 以左侧眶上和滑车上为蒂的骨膜瓣内层（红线）。 (B) 皮瓣通过额窦前壁上部的开口抵靠整个前颅底。 (C) 最终内窥镜视图，皮瓣覆盖整个前颅底，从右侧到左侧眼眶（分别为 RO 和 LO）横向，从额窦（白色箭头）到后方的鞍区。

鼻窦癌皮瓣或移植物重建手术的跨学科挑战和目标

根据手术切除肿瘤后缺损的位置和大小提出重建策略。

鼻窦癌皮瓣或移植物重建手术的跨学科挑战和目标

前臂软组织皮瓣重建手术后左腭鳞状细胞癌的术后放疗计划。 皮瓣（黄线）未被划定用于 RT 计划，并且已独立于转诊的放射肿瘤学家进行后验划定，并且对 CTV 划定视而不见。 辐射剂量分布分析表明，皮瓣被视为目标体积并接受了最高剂量处方水平（66 Gy，在红色 62.7Gy 等剂量范围内）。

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