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效果比较
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摘要
目的比较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临床疗效。方法选取2014年12月—2016年12月期间在温州医科大学附属第一医院进行修复口腔颌面部肿瘤根治术后缺损102例患者为研究对象,根据修复术的不同,将患者分为A组(股前外侧嵌合皮瓣修复)、B组(串联皮瓣修复),每组各51例。比较2组患者手术情况(手术时间、皮瓣制作与显微吻合时间、拔除胃管时间、经口进食时间)、术后恢复情况(满意度、外形修复、进食情况、工作情况、口腔闭合、张口度、咀嚼功能、吞咽功能、咬合功能、语言功能)、血清IL-2、s IL-2R、SA水平及术后并发症情况。结果 A组手术时间、拔除胃管时间、经口进食时间明显少于B组(P<0.05),皮瓣制作与显微吻合时间明显多于B组(P<0.05)。术后3个月,A组在满意度、外形修复、工作情况、口腔闭合、咀嚼功能、吞咽功能及语言功能等方面评分明显高于B组(P<0.05),在进食情况、容纳水测试、张口度及咬合功能等方面评分与B组比较差异无统计学意义(P>0.05)。术后1个月,2组血清IL-2水平明显升高(P<0.05),且A组显著高于B组(P<0.05);2组s IL-2R、SA水平明显降低(P<0.05),且A组显著低于B组(P<0.05)。A组出现血管危象发生率为3.92%,明显低于B组的17.65%(P<0.05)。结论股前外侧嵌合皮瓣修复口腔颌面部肿瘤根治术后缺损效果显著,可明显缩短手术时间,提高术后功能恢复,术后并发症发生率低。
Objective To analyze and compare the clinical effect of anterolateral chimeric flaps and tandem skin flap on repair of oral and maxillofacial tumors after radical surgery. Methods Total 102 patients with oral and maxillofacial tumors after radical surgery repair in our hospital between December,2014 and December,2016 were selected as study objects,and were divided into group A( anterolateral chimeric flaps),group B( tandem skin flap) according to the surgery methods,with 51 cases in each group. The surgical conditions( operation time,flap production and microsurgical anastomosis time,gastric tube removal time,oral feeding time),postoperative recovery( satisfaction,shape recovery,food intake,work condition,oral closure,mouth opening,chewing function,swallowing function,bite function,language function),and serum IL-2,s IL-2 R and SA levels of the two groups were compared. Results The operation time,gastric tube removal time and oral feeding time of group A were significantly lower than those of group B( P < 0. 05) and the production time and microscopic anastomosis time of group A were significantly higher than those of group B( P <0. 05). Three months after the surgery,the satisfaction,appearance repair,work condition,oral closure,masticatory function,swallowing function and language function of group A were significantly higher than those of group B( P <0. 05). One month after the operation,the serum IL-2 levels of the two groups were significantly increased,and the IL-2 level of group A was significantly higher than that of group B( P < 0. 05). One month after the operation,the serum s IL-2 R and SA levels of the two groups were significantly increased,and the level in group A was significantly lower than that in group B( P < 0. 05). The incidence of vascular crisis in group A was 3. 92%,which was significantly lower than that in group B(17. 65%,P < 0. 05). Conclusion The chimeric anterolateral skin flap can repair the defect of the maxillofacial tumor after radical operation,which can significantly shorten the operation time and improve the postoperative functional recovery. The incidence of postoperative complications is low.
Objective To analyze and compare the clinical effect of anterolateral chimeric flaps and tandem skin flap on repair of oral and maxillofacial tumors after radical surgery. Methods Total 102 patients with oral and maxillofacial tumors after radical surgery repair in our hospital between December,2014 and December,2016 were selected as study objects,and were divided into group A( anterolateral chimeric flaps),group B( tandem skin flap) according to the surgery methods,with 51 cases in each group. The surgical conditions( operation time,flap production and microsurgical anastomosis time,gastric tube removal time,oral feeding time),postoperative recovery( satisfaction,shape recovery,food intake,work condition,oral closure,mouth opening,chewing function,swallowing function,bite function,language function),and serum IL-2,s IL-2 R and SA levels of the two groups were compared. Results The operation time,gastric tube removal time and oral feeding time of group A were significantly lower than those of group B( P < 0. 05) and the production time and microscopic anastomosis time of group A were significantly higher than those of group B( P <0. 05). Three months after the surgery,the satisfaction,appearance repair,work condition,oral closure,masticatory function,swallowing function and language function of group A were significantly higher than those of group B( P <0. 05). One month after the operation,the serum IL-2 levels of the two groups were significantly increased,and the IL-2 level of group A was significantly higher than that of group B( P < 0. 05). One month after the operation,the serum s IL-2 R and SA levels of the two groups were significantly increased,and the level in group A was significantly lower than that in group B( P < 0. 05). The incidence of vascular crisis in group A was 3. 92%,which was significantly lower than that in group B(17. 65%,P < 0. 05). Conclusion The chimeric anterolateral skin flap can repair the defect of the maxillofacial tumor after radical operation,which can significantly shorten the operation time and improve the postoperative functional recovery. The incidence of postoperative complications is low.
引文
[1]陈洁,蒋灿华,尹乒,等.股前外侧free-style穿支皮瓣在口腔颌面部缺损修复重建中的应用[J].中华显微外科杂志,2015,38(1):20-24.
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[10]贾睿.不同部位皮瓣移植对口腔颌面部肿瘤根治术后皮瓣缺损部分修复重建效果的影响[J].中国现代药物应用,2017,11(19):43-44.
[11]Yamada S,Okamoto H,Sekiya I,et al.Anatomical basis of distally based anterolateral thigh flap[J].J Plast Surg Hand Surg,2014,48(3):197-200.
[12]杨何平,张洪武,陈海蒂,等.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.
[13]Goel S,Arora J,Mehta V,et al.Unusual disposition of lateral circumflex femoral artery:Anatomical description and clinical implications[J].World J Clin Cases,2015,3(1):85-88.
[14]Bhadkamkar MA,Wolfswinkel EM,Hatef DA,et al.The ultra-thin,fascia-only anterolateral thigh flap[J].J Reconstr Microsurg,2014,30(9):599-606.
[15]邵侠,叶鹏程,方一鸣,等.游离前臂皮瓣移植修复治疗口腔颌面部肿瘤切除后缺损47例分析[J].中华全科医学,2017,15(2):206-209.
[16]谭孟婷,杜友红,彭福森.带股外侧皮神经游离股前外侧皮瓣在口腔颌面部恶性肿瘤根治术后缺损修复重建中的应用[J].中国现代医药杂志,2016,18(1):33-34.
[2]刘堃,彭歆,毛驰.应用游离颏下皮瓣修复口腔癌术后组织缺损[J].中华显微外科杂志,2015,38(1):8-11.
[3]刘正武,黄海潞,何悦.血管化游离组织瓣修复口腔颌面部肿瘤术后缺损的临床效果[J].广西医学,2017,39(7):1021-1024.
[4]郭家平,王翔.游离皮瓣移植术对口腔颌面部肿瘤切除术后缺损的修复研究[J].实用癌症杂志,2016,31(6):915-917.
[5]Wei ZR,Sun GF,Wang DL,et al.Reconstruction of the Achilles tendon and overlying skin defect:3 case reports[J].Ann Plas Surg,2014,73(3):325-329.
[6]雷林革,袁崇喜,何如祥,等.游离股前外筋膜瓣修复手部软组织缺损[J].实用手外科杂志,2013,27(2):118-120.
[7]谢远鸿,丘仿松.股前外侧嵌合皮瓣修复口腔颌面部肿瘤术后缺损的效果[J].中国医学创新,2017,14(12):76-79.
[8]罗志强,南晓梅,叶钟泰.2085例口腔颌面部肿瘤疾病构成比分析[J].国际口腔医学杂志,2015,42(6):635-639.
[9]邵学垒,夏德林,张磊,等.不同类型的股前外侧皮瓣修复口腔颌面肿瘤术后软组织缺损[J].泸州医学院学报,2016,39(4):310-313.
[10]贾睿.不同部位皮瓣移植对口腔颌面部肿瘤根治术后皮瓣缺损部分修复重建效果的影响[J].中国现代药物应用,2017,11(19):43-44.
[11]Yamada S,Okamoto H,Sekiya I,et al.Anatomical basis of distally based anterolateral thigh flap[J].J Plast Surg Hand Surg,2014,48(3):197-200.
[12]杨何平,张洪武,陈海蒂,等.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.
[13]Goel S,Arora J,Mehta V,et al.Unusual disposition of lateral circumflex femoral artery:Anatomical description and clinical implications[J].World J Clin Cases,2015,3(1):85-88.
[14]Bhadkamkar MA,Wolfswinkel EM,Hatef DA,et al.The ultra-thin,fascia-only anterolateral thigh flap[J].J Reconstr Microsurg,2014,30(9):599-606.
[15]邵侠,叶鹏程,方一鸣,等.游离前臂皮瓣移植修复治疗口腔颌面部肿瘤切除后缺损47例分析[J].中华全科医学,2017,15(2):206-209.
[16]谭孟婷,杜友红,彭福森.带股外侧皮神经游离股前外侧皮瓣在口腔颌面部恶性肿瘤根治术后缺损修复重建中的应用[J].中国现代医药杂志,2016,18(1):33-34.