前臂皮瓣与颏下瓣在口腔癌术后组织缺损重建中的对比研究

发布时间：2018-04-28 10:19

本文选题：口腔癌 + 游离前臂皮瓣　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]比较游离前臂皮瓣与颏下岛状瓣在修复口腔癌术后组织缺损中的即刻修复和功能重建,评价两种皮瓣的临床价值及其特点。[方法]收集昆明医科大学附属口腔医院口腔颌面外科住院部自2013年6月-2016年9月以游离前臂皮瓣与颏下岛状瓣修复重建口腔癌术后组织缺损的49例病例。对49例口腔癌患者均行原发灶根治术并同期行游离前臂皮瓣或颏下岛状瓣即刻修复重建口腔癌切除术后组织缺损,其中行游离前臂皮瓣修复17例,颏下岛状瓣修复32例。通过利用SPSS21. 0分析比较两组患者的术前一般资料、手术时间、术后渗出液总量、皮瓣成活率、皮瓣及游离皮片感染坏死率及患者满意程度等情况。随访观察患者受区、供区外形及功能恢复状况,并通过华盛顿大学生存质量问卷(UW-QOL)评价观察患者术后生存质量。[结果]通过SPSS21.0分析统计患者的术前资料显示,两组患者的性别、平均年龄、病理分级及随访时间基本相似,比较差异无统计学意义(P0. 05)。游离前臂皮瓣组手术时间为(493. 70±93. 42) min,颏下岛状瓣组手术时间为(314. 93±82. 76) min,游离前臂皮瓣组手术时间明显高于颏下岛状瓣组,两者之间存在显著差异性(p 0.01);游离前臂皮瓣组术后渗出液量为(314. 70±125. 88) ml,颏下岛状瓣组术后渗出液量为(247. 31±102. 08) ml,游离前臂皮瓣组术后渗出液量明显高于颏下岛状瓣组,两者之间存在差异性,具有统计学意义(p 0.05);游离前臂皮瓣组皮瓣成活率为88.23% (15/17),低于颏下岛状瓣组的96.87% (31/32) (p0. 05);两组患者的受区及供区感染坏死率比较:游离前臂皮瓣组为29. 41% (5/17),高于颏下岛状瓣组的3.12% (1/32),两者之间存在差异性,具有统计学意义(p 0.05);两组患者术后受区的外形及功能恢复情况基本相近,但对于术后供区统计显示,游离前臂皮瓣组发生色素沉着、麻木感觉及暂时性的功能障碍的比率较颏下岛状瓣组明显,两者之间存在显著异性(P 0.05);术后通过对两组患者采用UW-QOL自评统计显示,游离前臂皮瓣组与颏下岛状瓣组患者总体生存质量无显著差异(P0. 05);两组患者满意度比较游离前臂皮瓣组为58. 8% (10/17),低于颏下岛状瓣组的90. 6%%(29/32),两组之间存在明显差异(P0. 05)。[结论]1.通过研究对比显示,游离前臂皮瓣与颏下岛状瓣均可较好的在口腔癌切除术后进行即刻修复和功能重建,两组患者术后生存质量及受区的外形及功能恢复情况基本相近。2.从手术时间、术后渗出液量、皮瓣成活率、皮瓣及游离皮片感染坏死率以及满意度来看,颏下岛状瓣组优于游离前臂皮瓣组。应用颏下岛状瓣可很好的降低术后供区的色素沉着、麻木或感觉异常及暂时性的功能障碍的发生,提升患者的满意度,如果条件允许,颏下岛状瓣是很好的选择,尤其是在不具备显微外科技术的基层医院。但对于有颈部淋巴结转移的病人应禁用该皮瓣。3.游离前臂皮瓣具有血管解剖变异小,血管蒂长,管径粗大,皮瓣柔韧可折叠,抗感染能力强等优势,对于口腔颌面部组织缺损较大或者颈淋巴结易发生早期转移的患者可选用游离前臂皮瓣。
[Abstract]:[Objective] to compare the immediate repair and functional reconstruction of the free forearm flap and submental island flap in the repair of tissue defects after oral cancer surgery. The clinical value and characteristics of the two kinds of flaps were evaluated. [Methods] the inpatient department of oral and maxillofacial surgery in the Affiliated Stomatological Hospital of Kunming Medical University was collected from the free forearm flap and the chin in September -2016 June 2013. 49 cases of reconstruction of tissue defect after oral cancer were repaired with island flap. 49 cases of oral cancer were treated with radical resection and immediate repair of tissue defect after free forearm flap or submental island flap. 17 cases were repaired with free forearm flap, 32 cases were repaired by submental island flap, and SPSS21. 0 was used. The general data of the two groups, the time of operation, the total amount of exudate, the survival rate of the flap, the infection necrosis rate of the skin flap and the free skin, and the satisfaction of the patients were observed. The following up and observation of the patient's receiving area, the shape and function of the donor area were observed, and the patients were evaluated after the operation by the UW-QOL. [results] the preoperative data of SPSS21.0 analysis showed that the sex, average age, pathological grade and follow-up time of the two groups were basically similar, and there was no significant difference (P0. 05). The operation time of the free forearm flap group was (493.70 + 93.42) min, and the operative time of submental island flap group was (314.93 + 82.76) M In, the operation time of the free forearm flap group was significantly higher than the submental island flap group, and there was a significant difference between the two groups (P 0.01). The exudative fluid volume of the free forearm flap group was (314.70 + 125.88) ml, the postoperative exudation of the submental island flap was (247.31 + 102.08) ml, and the amount of exudative fluid in the free forearm flap group was significantly higher than that of the submental island. The difference between the two groups was statistically significant (P 0.05); the survival rate of the free forearm flap group was 88.23% (15/17), lower than 96.87% (31/32) (p0. 05) of the submental island flap, and the rate of infection and necrosis in the two groups was 29.41% (5/17), higher than that of the submental island flap (3.12% (1/32)). The difference between the two was statistically significant (P 0.05). The shape and function recovery of the two groups were almost similar, but the postoperative donor site statistics showed that the free forearm flap group was pigmented, numbness and temporary dysfunction was more obvious than that in the submental island flap group. In the two groups of patients, the total quality of life was no significant difference between the free forearm flap group and the submental island flap group (P0. 05), and the two groups of patients were compared with the free forearm flap group of 58.8% (10/17) and 90. 6%% (29/32) lower than the submental island flap group, and the two groups were obvious between the two groups. The difference (P0. 05). [conclusion]1. shows that free forearm flap and submental island flap can be used for immediate repair and functional reconstruction after oral cancer resection. The quality of life and the shape and function recovery of the two groups after operation are basically similar to that of.2. from operation time, postoperative exudative fluid volume, skin flap survival rate and skin. The submental island flap is superior to the free forearm flap in the infection necrosis rate and the satisfaction of the submental island flap. The submental island flap can greatly reduce the pigmentation, numbness or abnormal sensation and temporary dysfunction in the donor area after the operation. The submental island flap is good if the condition is allowed. Choice, especially in primary hospitals that do not have microsurgical techniques, but for patients with cervical lymph node metastases, the flap of the.3. free forearm flap should be disable with small vascular anatomy, long vascular pedicle, large diameter, flexible flap, strong anti infection and other advantages, such as larger oral and maxillofacial defects or neck drenching. Free forearm flap can be used in patients with early metastasis.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.8

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