不同皮瓣对口腔颌面部肿瘤根治术后缺损的修复效果比较
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摘要
目的探讨不同皮瓣对口腔颌面部肿瘤根治术后缺损的临床修复效果。方法将行口腔颌面部肿瘤根治术后进行软组织修复的62例患者作为研究对象,随机分为研究组和对照组,各31例。对照组患者采用串联游离皮瓣进行修复,研究组患者采用股外侧嵌合皮瓣修复,观察2组患者各项手术指征的差异,并评价患者的修复效果。结果与对照组相比,研究组的手术时间、拔除胃管时间、经口进食时间明显较少,皮瓣制作和显微吻合时间明显多于对照组;术后3个月,与对照组相比,研究组患者皮瓣外形、患者满意度、工作状况、口腔闭合功能、语言表达、咀嚼、吞咽等功能明显较好(P <0. 05); 2组患者饮食、咬合和张口度比较,差异不显著(P> 0. 05)。研究组患者不良反应发生率明显低于对照组(P <0. 05)。结论相对于串联皮瓣来说,股外侧嵌合皮瓣修复术治疗口腔颌面部肿瘤术后缺损能够有效地缩短手术时间,促进术后口腔闭合、咀嚼、语言和吞咽功能的恢复,效果显著,可推广使用。
Objective To evaluate the clinical effect of different flap repair in the treatment of oral and maxillofacial tumors after radical resection. Methods 62 patients with soft tissue repair after oral surgery were enrolled. The patients were randomly divided into the study group and the control group( n = 31). The control group were treated with tandem flap for repair. The study group were treated with the lateral chimeric flap. The differences of the surgical indexes were observed and the repair effect was evaluated. Results The time of operation,the time of removal of gastric tube and the time of oral administration in the study group were significantly less than those of the control group. The time of skin flap production and microscopic coincidence was significantly higher than that of the control group. After 3 months,flap look,satisfaction of patients,working status,oral cavity closure,chewing and swallewing in the study group were better( P < 0. 05). There was no significant difference in diet,occlusion and mouth opening between the 2 groups( P > 0. 05),and the difference was statistically significant( P < 0. 05). The incidence of adverse reactions in the study group,was significantly lower than that of the control group( P < 0. 05). Conclusion The treatment of oral and maxillofacial tumors with interlocking flap repair can effectively shorten the operation time and promote the recovery of oral cavity closure,chewing,language and swallowing function. It is effective and can be promoted.
Objective To evaluate the clinical effect of different flap repair in the treatment of oral and maxillofacial tumors after radical resection. Methods 62 patients with soft tissue repair after oral surgery were enrolled. The patients were randomly divided into the study group and the control group( n = 31). The control group were treated with tandem flap for repair. The study group were treated with the lateral chimeric flap. The differences of the surgical indexes were observed and the repair effect was evaluated. Results The time of operation,the time of removal of gastric tube and the time of oral administration in the study group were significantly less than those of the control group. The time of skin flap production and microscopic coincidence was significantly higher than that of the control group. After 3 months,flap look,satisfaction of patients,working status,oral cavity closure,chewing and swallewing in the study group were better( P < 0. 05). There was no significant difference in diet,occlusion and mouth opening between the 2 groups( P > 0. 05),and the difference was statistically significant( P < 0. 05). The incidence of adverse reactions in the study group,was significantly lower than that of the control group( P < 0. 05). Conclusion The treatment of oral and maxillofacial tumors with interlocking flap repair can effectively shorten the operation time and promote the recovery of oral cavity closure,chewing,language and swallowing function. It is effective and can be promoted.
引文
[1]高祀琴,张永生.游离皮瓣移植应用于口腔颌面部恶性肿瘤切除术后对组织缺损的修复效果[J].国际医药卫生导报,2015,21(10):1409-1411.
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[8]Li-Qun XU,Zhang CP,Zhang ZY.Application of vascularized free flap in reconstruction of oral and maxillofacialhead and neck defect:A clinical analysis of 4640 cases[J].Journal of Practical Oncology,2015,30(1):18-21.
[9]郝春海.游离皮瓣修复口腔、颌面部恶性肿瘤术后组织缺损的应用现状[J].中国癌症防治杂志,2015,7(5):379-382.
[10]王友元,范松,林钊宇,等.折叠游离股前外侧皮瓣修复口腔颌面部恶性肿瘤术后颊部洞穿缺损[J].中华显微外科杂志,2016,39(1):41-45.
[11]Weizman N,Gil Z,Wasserzug O,et al.Surgical ablation and free flap reconstruction in children with malignant head and neck tumors[J].Skull Base,2011,21(3):165-170.
[2]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.
[3]曲昌锋,汪崇,杨建,等.颏下动脉岛状皮瓣修复口腔颌面部恶性肿瘤术后软组织缺损疗效分析[J].大连医科大学学报,2016,38(5):471-473.
[4]Arce K.Vascularized free tissue transfer for reconstruction of ablative defects in oral and oropharyngeal cancer patients undergoing salvage surgery following concomitant chemoradiation[J].Int J Oral Maxillofac Surg,2010,68(9):733-738.
[5]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.
[6]Guo F,Min AJ,Jiang CH,et al.Reconstruction of oral and maxillofacial defects using free anterolateral thigh flaps in patients with malignant tumors[J].Shanghai Kou Qiang Yi Xue,2011,20(1):62-65.
[7]克热木·阿巴司,赵莉,刘慧,等.游离组织皮瓣移植修复口腔颌面部恶性肿瘤切除术后组织缺损疗效及并发症观察[J].中国美容医学,2016,25(12):39-42.
[8]Li-Qun XU,Zhang CP,Zhang ZY.Application of vascularized free flap in reconstruction of oral and maxillofacialhead and neck defect:A clinical analysis of 4640 cases[J].Journal of Practical Oncology,2015,30(1):18-21.
[9]郝春海.游离皮瓣修复口腔、颌面部恶性肿瘤术后组织缺损的应用现状[J].中国癌症防治杂志,2015,7(5):379-382.
[10]王友元,范松,林钊宇,等.折叠游离股前外侧皮瓣修复口腔颌面部恶性肿瘤术后颊部洞穿缺损[J].中华显微外科杂志,2016,39(1):41-45.
[11]Weizman N,Gil Z,Wasserzug O,et al.Surgical ablation and free flap reconstruction in children with malignant head and neck tumors[J].Skull Base,2011,21(3):165-170.