面动脉黏膜肌皮瓣修复舌及口底肿瘤切除后缺损疗效观察

发布时间：2018-07-02 14:36

本文选题：舌及口底缺损 + 面动脉黏膜肌皮瓣　；参考：《中国修复重建外科杂志》2017年04期

【摘要】：目的探讨采用面动脉黏膜肌皮瓣修复舌及口底肿瘤切除后缺损的临床疗效。方法 2011年1 月—2016年1 月,采用面动脉黏膜肌皮瓣修复肿瘤切除后引起舌及口底组织缺损24例。其中男16例,女8例;年龄38~70岁,平均55岁。病程1周~6个月,平均4个月。缺损部位:口底4例,舌15例,口底舌腹5例。其中口底鳞癌2例,口底腺样囊性癌2例,舌鳞癌14例,舌腺样囊性癌1例,口底舌腹鳞癌5例。肿瘤切除后舌及口底缺损范围为4 cm×3 cm~8 cm×7 cm。切取面动脉黏膜肌皮瓣位于原发灶同侧3例,对侧21例(其中5例因缺损面积较大采用面动脉黏膜肌皮瓣及颏下肌岛状皮瓣共同修复)。面动脉黏膜肌皮瓣切取范围5 cm×4 cm~5 cm×5 cm,颏下肌岛状皮瓣切取范围4 cm×3 cm~5 cm×4 cm。结果术后所有皮瓣全部成活,无局部坏死发生。供区出现伤口裂开5例,经局部伤口清洗处理后愈合;余19例供受区创面Ⅰ期愈合。24例患者均获随访,随访时间8个月~5年,平均2年4个月。术后面部无明显畸形,无口底漏。术后16例出现面神经下颌缘支损伤临床表现,3个月后恢复正常。所有患者术后出现张口受限,1年后20例恢复正常,4例仍有张口2指受限。患者进食、吞咽、语言等功能均无影响。结论面动脉黏膜肌皮瓣手术简便、整复效果理想、皮瓣成活率较高、供区损伤少、术后护理简单、术后无需制动,适宜于舌及口底缺损修复。
[Abstract]:Objective to investigate the clinical effect of facial artery mucosal myocutaneous flap for repairing tongue and floor tumor after resection. Methods from January 2011 to January 2016, 24 cases of tongue and floor defects were repaired by facial artery mucosal myocutaneous flap. There were 16 males and 8 females, aged 3870 years with an average age of 55 years. The course of disease ranged from 1 week to 6 months (mean 4 months). There were 4 cases in the floor of the mouth, 15 cases in the tongue and 5 cases in the ventral part of the tongue. There were 2 cases of floor squamous cell carcinoma, 2 cases of adenoid cystic carcinoma, 14 cases of tongue squamous cell carcinoma, 1 case of tongue adenoid cystic carcinoma and 5 cases of tongue ventral squamous cell carcinoma. The area of tongue and floor defect after resection was 4 cm 脳 3 cm~8 cm 脳 7 cm. The facial artery mucosal myocutaneous flap was located in the same side in 3 cases and the contralateral in 21 cases (5 cases were repaired with facial artery mucosal myocutaneous flap and submental musculocutaneous flap due to the large area of defect). The area of facial artery musculocutaneous flap was 5 cm 脳 4 cm~5 cm 脳 5 cm, and the submental island flap was 4 cm 脳 3 cm~5 cm 脳 4 cm. Results all the flaps survived and no local necrosis occurred. There were 5 cases of wound dehiscence in donor area, which healed after local wound cleaning, the remaining 19 cases were followed up for 8 months to 5 years (mean 2 years and 4 months). There was no obvious deformity and no leakage of the floor of mouth after operation. The clinical manifestations of mandibular marginal branch injury of facial nerve were found in 16 cases after operation and returned to normal 3 months later. All the patients had limited opening of mouth after operation, 20 cases returned to normal after 1 year, 4 cases still had the limitation of open mouth and 2 fingers. The patients' eating, swallowing, language and other functions were not affected. Conclusion the facial artery mucosal myocutaneous flap is simple and effective, the survival rate of the flap is high, the donor area injury is less, postoperative nursing care is simple, and there is no need for braking after operation, which is suitable for repairing tongue and oral floor defect.
【作者单位】：桂林医学院附属医院口腔科;
【基金】：桂林市科学研究与技术开发计划项目(20140310-2-4)~~
【分类号】：R739.8

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