多种胸锁乳突肌瓣与游离皮瓣修复口腔癌缺损的效果比较
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摘要
目的 :通过比较胸锁乳突肌瓣与常用游离皮瓣用于不同年龄、原发灶大小及部位、颈部淋巴转移及全身情况的口腔癌患者的信息,为胸锁乳突肌瓣临床适应证的选择提供依据。方法:选择2015年9月—2018年3月由青岛大学附属医院同一术者手术的口腔癌患者58例,其中鳞状细胞癌53例,腺样囊性癌4例,下颌骨肉瘤1例。应用胸锁乳突肌瓣28例、游离皮瓣30例对口腔癌缺损进行同期修复。采用SPSS 22.0软件包分析2种皮瓣患者的基本信息、手术信息及术后功能状况。结果:与游离皮瓣相比,应用胸锁乳突肌瓣的患者原发灶面积多属T1～T2期,部位集中于舌、下牙龈、口底、舌根或口咽,平均年龄较大,术前合并全身疾病较多,手术费用低,手术时间短,术后住院天数少,气管切开率低(P<0.05)。术后随访提示,2组患者术后功能恢复相仿(P>0.05)。结论:口腔癌患者手术缺损选用胸锁乳突肌瓣或游离皮瓣修复,应综合考虑患者的年龄、原发灶大小及部位、颈部淋巴转移及全身情况等多种因素。对于高龄、原发灶较小、合并全身疾病较多的患者,建议多采用胸锁乳突肌瓣修复缺损。
PURPOSE: To compare the outcomes of using multiple kinds of sternocleidomastoid flap or free flaps to repair defects after oral cancer surgery. METHODS: Twenty-eight cases using sternocleidomastoid flaps and 30 cases using free flaps were included in this study. Operation was performed in 58 patients with oral cavity cancer. The basic and surgical informations, and postoperative function were analyzed between two groups with SPSS 22.0 software package. RESULTS:The tumor size mostly belonged to T1-T2, and the primary sites were the tongue, lower gingiva, floor of mouth, base of tongue or oropharynx in patients undergoing sternocleidomastoid flaps, whose average age was higher, surgical time was shorter, systemic diseases was more serious, and surgical cost, hospital stay, tracheotomy rate was less than patients undergoing free flaps(P <0.05). Patients in the two groups had similar oral function after surgery(P >0.05).CONCLUSIONS: Selection of sternocleidomastoid flaps or free flaps for repairing oral cancer defects is dependent on a variety of factors such as the age of patients, the size and location of tumor, metastasis of cervical lymph nodes and the general conditions. Sternocleidomastoid flap is a good choice for patients with advanced ages, small size of lesions(T1-T2)and concomitant systemic diseases.
PURPOSE: To compare the outcomes of using multiple kinds of sternocleidomastoid flap or free flaps to repair defects after oral cancer surgery. METHODS: Twenty-eight cases using sternocleidomastoid flaps and 30 cases using free flaps were included in this study. Operation was performed in 58 patients with oral cavity cancer. The basic and surgical informations, and postoperative function were analyzed between two groups with SPSS 22.0 software package. RESULTS:The tumor size mostly belonged to T1-T2, and the primary sites were the tongue, lower gingiva, floor of mouth, base of tongue or oropharynx in patients undergoing sternocleidomastoid flaps, whose average age was higher, surgical time was shorter, systemic diseases was more serious, and surgical cost, hospital stay, tracheotomy rate was less than patients undergoing free flaps(P <0.05). Patients in the two groups had similar oral function after surgery(P >0.05).CONCLUSIONS: Selection of sternocleidomastoid flaps or free flaps for repairing oral cancer defects is dependent on a variety of factors such as the age of patients, the size and location of tumor, metastasis of cervical lymph nodes and the general conditions. Sternocleidomastoid flap is a good choice for patients with advanced ages, small size of lesions(T1-T2)and concomitant systemic diseases.
引文
[1] Keraw ala C, Roques T, Jeannon J, et al. Oral cavity and lip cancer:United kingdom national multidisciplinary guidelines[J].J Laryngol Otol, 2016, 130(S2):S83-89.
[2]邱蔚六.口腔颌面部癌瘤治疗的新理念—浅析综合序列治疗[J].上海第二医科大学学报(医学版), 2005, 25(4):321-324.
[3]温玉明,华成舸,王昌美,等.口腔癌的综合治疗[J].中华口腔医学杂志, 2003, 38(1):73-75.
[4] Adelstein D, Gillison ML, Pfister DG, et al. NCCN guidelines insights:Head and neck cancers, version 2.2017[J]. J Natl Compr Canc Netw, 2017, 15(6):761-770.
[5] Owens N. A compound neck pedicle designed for the repair of massive facial defects:Formation, development and application[J].Plast Reconstr Surg, 1955, 15(5):369-389.
[6]罗加仁.胸锁乳突肌皮瓣[J].国外医学·口腔医学分册, 1981,8(4):205-207.
[7] Conley J, Gullane PJ. The sternocleidomastoid muscle flap[J].Head Neck Surg, 1980, 2(4):308-311.
[8] Ariyan S. One-stage reconstruction for defects of the mouth using a sternomastoid myocutaneous flap[J]. Plast Reconstr Surg, 1979,63(5):618-625.
[9] Brandwein-Gensler M, Smith RV. Prognostic indicators in head and neck oncology including the new 7th edition of the AJCC staging system[J]. Head Neck Pathol, 2010, 4(1):53-61.
[10]张陈平.口腔癌治疗规范的思考[J].中国肿瘤临床, 2010, 37(16):905-907.
[11]卢敏,高克明.胸锁乳突肌的血管构筑[J].解剖学杂志, 2000,23(5):465-468.
[12]许本柯,舒先涛,罗刚,等.胸锁乳突肌锁骨头的血供及应用解剖[J].解剖学杂志, 2006, 29(3):357-359.
[2]邱蔚六.口腔颌面部癌瘤治疗的新理念—浅析综合序列治疗[J].上海第二医科大学学报(医学版), 2005, 25(4):321-324.
[3]温玉明,华成舸,王昌美,等.口腔癌的综合治疗[J].中华口腔医学杂志, 2003, 38(1):73-75.
[4] Adelstein D, Gillison ML, Pfister DG, et al. NCCN guidelines insights:Head and neck cancers, version 2.2017[J]. J Natl Compr Canc Netw, 2017, 15(6):761-770.
[5] Owens N. A compound neck pedicle designed for the repair of massive facial defects:Formation, development and application[J].Plast Reconstr Surg, 1955, 15(5):369-389.
[6]罗加仁.胸锁乳突肌皮瓣[J].国外医学·口腔医学分册, 1981,8(4):205-207.
[7] Conley J, Gullane PJ. The sternocleidomastoid muscle flap[J].Head Neck Surg, 1980, 2(4):308-311.
[8] Ariyan S. One-stage reconstruction for defects of the mouth using a sternomastoid myocutaneous flap[J]. Plast Reconstr Surg, 1979,63(5):618-625.
[9] Brandwein-Gensler M, Smith RV. Prognostic indicators in head and neck oncology including the new 7th edition of the AJCC staging system[J]. Head Neck Pathol, 2010, 4(1):53-61.
[10]张陈平.口腔癌治疗规范的思考[J].中国肿瘤临床, 2010, 37(16):905-907.
[11]卢敏,高克明.胸锁乳突肌的血管构筑[J].解剖学杂志, 2000,23(5):465-468.
[12]许本柯,舒先涛,罗刚,等.胸锁乳突肌锁骨头的血供及应用解剖[J].解剖学杂志, 2006, 29(3):357-359.