股前外侧嵌合皮瓣与串联皮瓣修复口腔颌面部肿瘤根治术后缺损的疗效比较

发布时间：2018-05-15 22:13

本文选题：股前外侧嵌合皮瓣 + 串联皮瓣　；参考：《中国修复重建外科杂志》2016年04期

【摘要】：目的比较股前外侧嵌合皮瓣及串联皮瓣修复口腔颌面部肿瘤根治术后缺损的疗效。方法回顾分析2011年1月-2014年7月39例采用股前外侧嵌合皮瓣修复口腔颌面部肿瘤根治术后缺损患者(嵌合皮瓣组)临床资料,以2009年1月-2010年12月采用串联游离皮瓣修复的35例患者(串联皮瓣组)作为对照。两组患者性别、年龄、病程、肿瘤类型、肿瘤分期及缺损范围、部位等一般资料比较,差异均无统计学意义(P0.05),具有可比性。记录并比较两组手术时间、皮瓣制作及显微吻合时间、拔除胃管时间、开始经口进食时间,观察并发症发生情况;参照口腔颌面肿瘤根治术后骨与软组织缺损修复重建后临床疗效评估表(华盛顿大学生存质量量表)评价疗效。结果术后嵌合皮瓣组2例、串联皮瓣组4例皮瓣出现血管危象,串联皮瓣组1例皮瓣远心端出现部分坏死,串联皮瓣组3例出现口底颌下瘘和感染;其余患者皮瓣顺利成活,受区创面Ⅰ期愈合。供区植皮均顺利成活,切口Ⅰ期愈合。嵌合皮瓣组手术时间、拔除胃管时间、开始经口进食时间均显著少于串联皮瓣组,皮瓣制作及显微吻合时间长于对照组,比较差异均有统计学意义(P0.05)。两组患者均获随访,随访时间1~5年,平均2.5年。术后3个月,根据口腔颌面肿瘤根治术后骨与软组织缺损修复重建后临床疗效评估表,嵌合皮瓣组术后外形、患者满意度、工作状况、口腔闭合功能、咀嚼、语言表达、吞咽评分均显著高于串联皮瓣组(P0.05);饮食、张口度、口腔容纳水测试及咬合评分比较,差异无统计学意义(P0.05)。结论与串联皮瓣相比,股前外侧嵌合皮瓣修复口腔颌面部肿瘤术后缺损能缩短手术时间、加快术后康复,同时有利于患者术后口腔闭合、咀嚼、语言、吞咽功能恢复。
[Abstract]:Objective to compare the efficacy of anterolateral femoral flap and series flap in repairing oral and maxillofacial tumor defects. Methods from January 2011 to July 2014, 39 patients with oral and maxillofacial tumor defects (chimeric flap group) were treated with anterolateral femoral chimeric flap. From January 2009 to December 2010, 35 patients (series flap group) were treated with series free flap as control group. There were no significant differences in sex, age, course of disease, tumor type, tumor stage, defect area and location between the two groups, and there was no significant difference between the two groups (P 0.05). The operation time, the time of flap fabrication and microanastomosis, the time of removing gastric tube and the time of feeding through mouth were recorded and compared between the two groups, and the complications were observed. To evaluate the clinical efficacy of bone and soft tissue defect reconstruction after radical resection of oral and maxillofacial tumors (University of Washington quality of Life scale). Results there were 2 cases in the chimeric flap group, 4 cases in the series flap group, 1 case in the series flap group with partial necrosis at the distal end of the flap, 3 cases with submaxillary fistula and infection in the series flap group. The wound of recipient area was healed in the first stage. The donor skin grafts survived successfully and the incision healed in the first stage. In the chimeric flap group, the time of operation, extraction of gastric tube and beginning of oral feeding were significantly shorter than those in the series flap group, and the time of flap fabrication and microanastomosis was longer than that of the control group, and the difference was statistically significant (P 0.05). The patients in both groups were followed up for 1 ~ 5 years (mean 2.5 years). 3 months after operation, according to the clinical evaluation table of bone and soft tissue defect reconstruction after radical resection of oral and maxillofacial tumor, the postoperative appearance, patient satisfaction, work status, oral closure function, mastication and language expression of chimeric flap group were analyzed. The score of swallowing was significantly higher than that of the series flap group (P 0.05), but there was no significant difference in diet, mouth opening, oral water inclusion test and occlusal score. Conclusion compared with the series flaps, the repair of oral and maxillofacial tumor defects by the anterolateral femoral chimeric flap can shorten the operative time and accelerate the postoperative recovery. It is also beneficial to the recovery of oral cavity closure, mastication, language and swallowing after operation.
【作者单位】：湘潭市中心医院口腔颌面外科;
【基金】：湘潭市科技计划资助项目(ZJ20131018)~~
【分类号】：R739.8

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