颏下岛状皮瓣和前臂皮瓣修复舌体缺损的对比性研究

发布时间：2018-07-24 14:59

【摘要】：目的比较颏下岛状皮瓣（Submental Island Flap，SIF）和前臂皮瓣（Radial Forearm Flap，RFF）在修复舌癌术后半舌缺损中的临床应用效果，探讨颏下岛状皮瓣在舌癌术后组织缺损修复中的应用价值。方法对广西医科大学附属肿瘤医院头颈外科2002年8月至2009年6月收治的45例舌癌患者，行舌癌根治术后同期分别应用颏下岛状皮瓣（n=18）及前臂桡侧皮瓣（n=27）修复半舌缺损，比较两种皮瓣制备的手术时间、出血量和术后并发症，并观察和比较患者术后舌体外形恢复程度、舌活动度、语言、咀嚼及吞咽功能等情况。结果应用颏下岛状皮瓣和前臂皮瓣修复的平均制备时间分别为（46.83±7.75）min、（61.25±10.79）min，颏下岛状皮瓣制备的手术时间明显短于前臂皮瓣制备的手术时间（P㩳0.05）；颏下岛状皮瓣和前臂皮瓣制备的平均出血量分别为（24.44±4.04）ml、（28.81±5.49） ml，颏下岛状皮瓣制备的出血量明显小于前臂皮瓣（P㩳0.01）。18例采用颏下岛状皮瓣修复，1例出现皮瓣远端部分坏死，伤口延期愈合，1例出现皮岛坏死，，清创后发现肌瓣血运良好,皮瓣移植成功率94.44%（17/18），供区直接拉拢缝合；27例前臂皮瓣修复，1例因静脉血栓出现术后皮瓣坏死，抢救无效清创后直接拉拢缝合，皮瓣移植成功率96.30%（26/27），供区均行全厚皮片移植，前臂局部遗留较大手术瘢痕。两组病例术后均无口底瘘、颈部切口感染等并发症发生。两种皮瓣修复成功率比较差异无统计学意义（P＞0.05）。两组病例术后6个月随访，舌体外形恢复基本满意，舌活动度、语言、咀嚼及吞咽功能相近（P均＞0.05）。结论在半舌缺损修复中，颏下岛状皮瓣具有制备简单、用时短、出血少、伤口隐蔽和与前臂皮瓣相似的功能康复效果等优点，是前臂皮瓣修复的补充和半舌缺损修复有效手段之一，尤其适用于对外形美观要求较高的中青年舌癌患者。对伴有颈淋巴结转移的舌癌患者应用颏下岛状皮瓣修复应慎重。
[Abstract]:Objective to compare the clinical effects of submental island flap (Submental Island flap( Submental Island) and forearm flap (Radial Forearm flap( Submental Island) in the repair of tongue defect after tongue cancer operation, and to explore the value of submental island flap in the repair of tissue defect after tongue cancer operation. Methods from August 2002 to June 2009, 45 patients with tongue cancer were treated with submental island flap (nong18) and forearm radial flap (nf27) respectively after radical operation of tongue cancer, and half tongue defect was repaired with submental island flap (nf18) and forearm radial flap (nf27), respectively, from August 2002 to June 2009 in the Department of head and neck surgery, affiliated Cancer Hospital of Guangxi Medical University. The operative time, blood loss and postoperative complications of the two flaps were compared, and the recovery degree of tongue body shape, tongue movement, language, masticatory and swallowing function were observed and compared. Results the average preparation time of submental island flap and forearm flap was (46.83 卤7.75) min, (, 61.25 卤10.79) mins, respectively. The operative time of submental island flap was significantly shorter than that of forearm flap (P0. 05). The mean blood loss of submental island flap and forearm flap was (24.44 卤4.04) ml, (28.81 卤5.49) ml, respectively. The blood loss of submental island flap was significantly lower than that of forearm flap (P0. 01). 18 cases of submental island flap were repaired with submental island flap. Skin island necrosis was found in 1 case of delayed wound healing. Good blood flow of muscle flap was found after debridement. The successful rate of flap transplantation was 94.44% (17 / 18). 27 cases of forearm flap were repaired by direct closure and suture of donor area, and 1 case had postoperative flap necrosis due to venous thrombosis. The successful rate of flap transplantation was 96.30% (26 / 27). All the donor areas were treated with full-thickness skin grafts and the forearm was left with large surgical scars. There were no postoperative complications such as fundus fistula and infection of neck incision in both groups. There was no significant difference in the successful rate of repair between the two flaps (P > 0.05). The patients in both groups were followed up 6 months after operation. The results showed that the tongue-body shape was basically satisfactory, tongue movement, speech, masticatory and swallowing function were similar (P > 0.05). Conclusion the submental island flap has the advantages of simple preparation, short time use, less bleeding, concealment of wound and functional rehabilitation similar to that of forearm flap in the repair of half-tongue defect. It is one of the effective methods for repairing forearm flap and half tongue defect, especially for young and middle-aged patients with tongue cancer. The submental island flap should be carefully used in the repair of tongue cancer with cervical lymph node metastasis.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.63

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