股前外侧嵌合皮瓣修复口腔颌面部肿瘤术后缺损的效果
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摘要
目的:比较股前外侧嵌合皮瓣修复术与串联皮瓣修复术对口腔颌面部肿瘤术后缺损的疗效。方法:回顾性分析2013年4月-2016年9月本院接收的43例口腔颌面部肿瘤根治术后缺损行股前外侧嵌合皮瓣修复术的患者资料作为研究组,以2010年4月-2013年3月采取串联游离皮瓣修复术的30例患者资料作为对照组。比较两组患者的手术时间、皮瓣制作及显微吻合时间、拔除胃管经口进食时间、治疗效果。结果:研究组患者的手术时间、拔除胃管时间、经口进食时间均显著短于对照组,皮瓣制作与显微吻合时间长于对照组,差异均有统计学意义(P<0.05)。术后随访3个月,研究组患者的外形修复、口腔开合、吞咽、咀嚼、语言功能的评分均高于对照组,差异均有统计学意义(P<0.05),两组的进食、容纳水测试、咬合评分方面比较,差异均无统计学意义(P>0.05)。研究组出现血管危象2例,少于对照组的6例,差异有统计学意义(P<0.05);且对照组患者出现1例皮瓣远心端部分坏死,4例颌面底下瘘并发感染;其余患者皮瓣均成活,创面Ⅰ期愈合。供区植皮均成活,切口Ⅰ期愈合。结论:股前外侧嵌合皮瓣修复术对口腔颌面部肿瘤术后缺损的疗效显著,手术时间短、术后康复快,患者的口腔开合、吞咽、咀嚼、语言等功能恢复良好。
Objective:To compare the effect of the anterior and lateral thigh flap repairing method and the serial flap repairing method after the repairing of oral and maxillofacial tumors.Method:43 cases of radical resection oral and maxillofacial tumor from April 2013 to September 2016 after the repair of defect of anterolateral thigh chimeric flap of the research group,and 30 patients from April 2010 to March 2013 which took the serial flap of control group.The operation time,flap and microanastomosis time,extubation time of oral intake of two groups were compared.Result:The operation time,the time of extubation,and the time of oral feeding of research group were significantly shorter than those of the control group,the time of flap preparation and microsurgical anastomosiswas longer than that of the control group,the differences were statistically significant(P<0.05).All patients were followed up for 3 months,the scores of shape restoration,mouth opening and closing,swallowing,chewing,and language function of the patients in the research group were higher than those in the control group,the differences were statistically significant(P<0.05),there were no significant differences between the two groups in terms of diet,water intake test,and occlusal score(P>0.05).Vascular crisis occurred in 2 cases in the research group,which was less than 6 cases in the control group,the difference was statistically significant(P<0.05);in the control group,there were 4 cases of distal necrosis of the distal part of the flap,and the infection of maxillofacial fistula in 1 case.The other flaps survived and the wound healed by first intention.Conclusion:The effect of anterolateral thigh flap in the repair of oral and maxillofacial tumors after operation is significant,the operation time is short,the postoperative recovery is fast,and the patient's mouth opening and closing, swallowing, chewing, language and other functions recovered well.
Objective:To compare the effect of the anterior and lateral thigh flap repairing method and the serial flap repairing method after the repairing of oral and maxillofacial tumors.Method:43 cases of radical resection oral and maxillofacial tumor from April 2013 to September 2016 after the repair of defect of anterolateral thigh chimeric flap of the research group,and 30 patients from April 2010 to March 2013 which took the serial flap of control group.The operation time,flap and microanastomosis time,extubation time of oral intake of two groups were compared.Result:The operation time,the time of extubation,and the time of oral feeding of research group were significantly shorter than those of the control group,the time of flap preparation and microsurgical anastomosiswas longer than that of the control group,the differences were statistically significant(P<0.05).All patients were followed up for 3 months,the scores of shape restoration,mouth opening and closing,swallowing,chewing,and language function of the patients in the research group were higher than those in the control group,the differences were statistically significant(P<0.05),there were no significant differences between the two groups in terms of diet,water intake test,and occlusal score(P>0.05).Vascular crisis occurred in 2 cases in the research group,which was less than 6 cases in the control group,the difference was statistically significant(P<0.05);in the control group,there were 4 cases of distal necrosis of the distal part of the flap,and the infection of maxillofacial fistula in 1 case.The other flaps survived and the wound healed by first intention.Conclusion:The effect of anterolateral thigh flap in the repair of oral and maxillofacial tumors after operation is significant,the operation time is short,the postoperative recovery is fast,and the patient's mouth opening and closing, swallowing, chewing, language and other functions recovered well.
引文
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[9]郭永明,刘重,滕云升,等.以旋股外侧动脉降支为蒂的穿支嵌合皮瓣治疗跟骨慢性骨髓炎11例[J].中华显微外科杂志,2015,38(5):476-478.
[10]宋达疆,李赞,周晓,等.应用不同入路切取股前外侧皮瓣行舌癌切除后缺损的修复重建[J].中国耳鼻咽喉颅底外科杂志,2016,22(2):129-133.
[11]李涛,雷荣昌,黎钢.胸大肌肌皮瓣在口腔颌面部肿瘤切除后修复中的应用分析[J].医学信息,2014,27(25):124-125.
[12]王德亮,李春明.常见皮瓣修复口腔颌面部缺损的研究进展[J].中国美容医学,2013,22(3):407-410.
[2]管宏伟,郑晓涛.口腔颌面部血管畸形临床治疗[J].中国伤残医学,2013,21(11):174-175.
[3]任振虎,吴汉江,谭宏宇,等.1212块股股前外侧肌皮瓣在口腔颌面缺损修复中的应用[J].华西口腔医学杂志,2015,33(3):281-285.
[4]罗世洪,肖金刚,孙黎波,等.股前外侧肌皮瓣及CT血管造影在修复中晚期口底癌术后缺损中的应用[J].华西口腔医学杂志,2015,33(4):409-413.
[5]Na D,Wei H,Rui L,et al.Assessment of the quality of life of oral cancer patients after reconstruction with free anterolateral thigh perforator flaps[J].West China Journal of Stomatology,2015,33(2):197-200.
[6]杨何平,张洪武,陈海蒂,等.股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[J].中国修复重建外科杂志,2016,30(4):447-452.
[7]王欣,潘佳栋,黄耀鹏,等.Ⅰ期移植复合股股前外侧穿支皮瓣治疗ⅢC型开放性损伤[J].中华创伤杂志,2014,30(5):433-437.
[8]韩新生,张卓远,黄怡,等.舌鳞状细胞癌细胞与正常黏膜细胞微泡的差异蛋白组学研究[J].华西口腔医学杂志,2014,32(3):283-287.
[9]郭永明,刘重,滕云升,等.以旋股外侧动脉降支为蒂的穿支嵌合皮瓣治疗跟骨慢性骨髓炎11例[J].中华显微外科杂志,2015,38(5):476-478.
[10]宋达疆,李赞,周晓,等.应用不同入路切取股前外侧皮瓣行舌癌切除后缺损的修复重建[J].中国耳鼻咽喉颅底外科杂志,2016,22(2):129-133.
[11]李涛,雷荣昌,黎钢.胸大肌肌皮瓣在口腔颌面部肿瘤切除后修复中的应用分析[J].医学信息,2014,27(25):124-125.
[12]王德亮,李春明.常见皮瓣修复口腔颌面部缺损的研究进展[J].中国美容医学,2013,22(3):407-410.