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
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摘要
目的比较股前外侧嵌合皮瓣及串联皮瓣修复口腔颌面部肿瘤根治术后缺损的疗效。方法回顾分析2011年1月-2014年7月39例采用股前外侧嵌合皮瓣修复口腔颌面部肿瘤根治术后缺损患者(嵌合皮瓣组)临床资料,以2009年1月-2010年12月采用串联游离皮瓣修复的35例患者(串联皮瓣组)作为对照。两组患者性别、年龄、病程、肿瘤类型、肿瘤分期及缺损范围、部位等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较两组手术时间、皮瓣制作及显微吻合时间、拔除胃管时间、开始经口进食时间,观察并发症发生情况;参照口腔颌面肿瘤根治术后骨与软组织缺损修复重建后临床疗效评估表(华盛顿大学生存质量量表)评价疗效。结果术后嵌合皮瓣组2例、串联皮瓣组4例皮瓣出现血管危象,串联皮瓣组1例皮瓣远心端出现部分坏死,串联皮瓣组3例出现口底颌下瘘和感染;其余患者皮瓣顺利成活,受区创面Ⅰ期愈合。供区植皮均顺利成活,切口Ⅰ期愈合。嵌合皮瓣组手术时间、拔除胃管时间、开始经口进食时间均显著少于串联皮瓣组,皮瓣制作及显微吻合时间长于对照组,比较差异均有统计学意义(P<0.05)。两组患者均获随访,随访时间1~5年,平均2.5年。术后3个月,根据口腔颌面肿瘤根治术后骨与软组织缺损修复重建后临床疗效评估表,嵌合皮瓣组术后外形、患者满意度、工作状况、口腔闭合功能、咀嚼、语言表达、吞咽评分均显著高于串联皮瓣组(P<0.05);饮食、张口度、口腔容纳水测试及咬合评分比较,差异无统计学意义(P>0.05)。结论与串联皮瓣相比,股前外侧嵌合皮瓣修复口腔颌面部肿瘤术后缺损能缩短手术时间、加快术后康复,同时有利于患者术后口腔闭合、咀嚼、语言、吞咽功能恢复。
Objective To compare the effectiveness of complex defects repair between using chimeric anterolateral thigh flap and series-wound flaps after resection of oral and maxillofacial cancer. Methods After resection of oral and maxillofacial cancer, defect was repaired with chimeric anterolateral thigh flap in 39 patients between January 2011 and July 2014(chimeric anterolateral thigh flap group); and defect was repaired with series-wound flaps in 35 patients between January 2009 and December 2010(series-wound flaps group). There was no significant difference in gender, age, duration of disease, tumor type, tumor staging, defect location, and defect area between 2 groups(P>0.05). The operation time, flap harvesting and microvascular anastomosis time, stomach tube extraction time, and oral feeding time were recorded and compared between 2 groups, and postoperative complications were observed; the effectiveness was evaluated according to clinical efficacy evaluation table of bone and soft tissue defects reconstruction surgery in oral and maxillofacial region. Results Vascular crisis occurred in 2 cases of chimeric anterolateral thigh flap group, and 4 cases of series-wound flaps group. Partial necrosis appeared at distal end of a series-wound flaps, and oral fistula and infection developed in 3 series-wound flaps. The other flaps and the grafted skin at donor site survived; wounds at recipient site healed by first intention. The operation time, stomach tube extraction time, and oral feeding time of chimeric anterolateral thigh flap group were significantly shorter than those of series-wound flaps group(P<0.05), while the flap harvesting and microvascular anastomosis time was significantly longer than that of series-wound flaps group(P<0.05). The patients were followed up 1-5 years(mean, 2.5 years). At 3 months after operation, the appearance, patients' satisfaction, working conditions, oral closure function, chew, language performance, and swallowing scores of the chimeric anterolateral thigh flap group were significantly better than those of the series-wound flaps group(P<0.05), while there was no significant difference in diet, mouth opening degree, oral cavity holding water test, and occlusion scores between the 2 groups(P>0.05). Conclusion Using chimeric anterolateral thigh flap for defect repair after resection of oral and maxillofacial cancer can significantly shorten the operation time, accelerate postoperative rehabilitation, and help the functional recovery of oral closure, chewing, language performance, swallowing function when compared with the series-wound flaps.
Objective To compare the effectiveness of complex defects repair between using chimeric anterolateral thigh flap and series-wound flaps after resection of oral and maxillofacial cancer. Methods After resection of oral and maxillofacial cancer, defect was repaired with chimeric anterolateral thigh flap in 39 patients between January 2011 and July 2014(chimeric anterolateral thigh flap group); and defect was repaired with series-wound flaps in 35 patients between January 2009 and December 2010(series-wound flaps group). There was no significant difference in gender, age, duration of disease, tumor type, tumor staging, defect location, and defect area between 2 groups(P>0.05). The operation time, flap harvesting and microvascular anastomosis time, stomach tube extraction time, and oral feeding time were recorded and compared between 2 groups, and postoperative complications were observed; the effectiveness was evaluated according to clinical efficacy evaluation table of bone and soft tissue defects reconstruction surgery in oral and maxillofacial region. Results Vascular crisis occurred in 2 cases of chimeric anterolateral thigh flap group, and 4 cases of series-wound flaps group. Partial necrosis appeared at distal end of a series-wound flaps, and oral fistula and infection developed in 3 series-wound flaps. The other flaps and the grafted skin at donor site survived; wounds at recipient site healed by first intention. The operation time, stomach tube extraction time, and oral feeding time of chimeric anterolateral thigh flap group were significantly shorter than those of series-wound flaps group(P<0.05), while the flap harvesting and microvascular anastomosis time was significantly longer than that of series-wound flaps group(P<0.05). The patients were followed up 1-5 years(mean, 2.5 years). At 3 months after operation, the appearance, patients' satisfaction, working conditions, oral closure function, chew, language performance, and swallowing scores of the chimeric anterolateral thigh flap group were significantly better than those of the series-wound flaps group(P<0.05), while there was no significant difference in diet, mouth opening degree, oral cavity holding water test, and occlusion scores between the 2 groups(P>0.05). Conclusion Using chimeric anterolateral thigh flap for defect repair after resection of oral and maxillofacial cancer can significantly shorten the operation time, accelerate postoperative rehabilitation, and help the functional recovery of oral closure, chewing, language performance, swallowing function when compared with the series-wound flaps.
引文
1魏在荣.影响皮瓣成活的血管因素分析.中国美容整形外科杂志,2014,25(3):129-131.
2 王金龙,徐斌,王兵,等.髂腹股沟皮瓣联合带蒂股前外侧皮瓣修复手部大面积皮肤缺损.重庆医学,2013,42(2):197-198.
3 陈睿,李雯娟,杨凯,等.股前外侧皮瓣在口腔颌面外科的临床应用.重庆医科大学学报,2014,39(8):1160-1162.
4 徐立群,张陈平,张志愿,等.血管化游离组织瓣在口腔颌面-头颈部缺损修复中的应用(4640例临床分析).实用肿瘤杂志,2015,30(1):18-21.
5 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.实用手外科杂志,2013,27(2):118-120.
6 Yamada S,Okamoto H,Sekiya I,et al.Anatomical basis of distally based anterolateral thigh flap.J Plast Surg Hand Surg,2014,48(3):197-200.
7 Wei ZR,Sun GF,Wang DL,et al.Reconstruction of the Achilles tendon and overlying skin defect:3 case reports.Ann Plast Surg,2014,73(3):325-329.
8 Zhuang Y,Hu S,Wu D,et al.A novel in vivo technique for observations of choke vessels in a rat skin flap model.Plast Reconstr Surg,2012,130(2):308-317.
9 Ao M,Asagoe K,Maeta M.Combined anterior thigh flaps and vascularized fibular graft for reconstruction of massive composite oromandibular defects.Br J Plast Surg,1998,51(5):350-355.
10 Singh B,Cordeiro PG,Santamaria E,et al.Factors associated with complications in microvascular reconstruction of head and neck defects.Plast Reconstr Surg,1999,103(2):403-411.
11 Yu P.Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction.Head Neck,2004,26(9):759-769.
12 Rogers SN,Lowe D.The University of Washington Quality of Life Scale//Handbook of Disease Burdens and Quality of Life Measures.New York:Springer,2010:101-128.
13 罗瑞华,齐金星,赵铭,等.削薄股前外侧皮瓣游离移植修复舌癌术后缺损的临床疗效.武汉大学学报(医学版),2012,33(4):585-586,593.
14 唐修俊,魏在荣,王波,等.游离旋股外侧动脉穿支KISS皮瓣修复四肢创面的临床应用.中华显微外科杂志,2015,38(1):29-32.
15 Hallock GG.Simultaneous transposition of anterior thigh muscle and fascia flaps:an introduction to the chimera flap principle.Ann Plast Surg,1991,27(2):126-131.
16 杜学亮,陈平,杜永军,等.串联皮瓣修复大面积颅骨外露.中国美容医学,2012,21(3):360-362.
17 徐中飞,代炜,张恩礁,等.股前外侧穿支嵌合皮瓣修复头颈肿瘤根治术后缺损.上海口腔医学,2012,21(1):107-112.
18 陈洁,蒋灿华,闵安杰,等.旋髂深动脉穿支嵌合髂骨皮瓣修复下颌骨复合性缺损.华西口腔医学杂志,2015,33(3):276-280.
19 Bhadkamkar MA,Wolfswinkel EM,Hatef DA,et al.The ultrathin,fascia-only anterolateral thigh flap.J Reconstr Microsurg,2014,30(9):599-606.
20 Goel S,Arora J,Mehta V,et al.Unusual disposition of lateral circumflex femoral artery:Anatomical description and clinical implications.World J Clin Cases,2015,3(1):85-88.
21 Lee YC,Chen WC,Chou TM,et al.Anatomical variability of the anterolateral thigh flap perforators:vascular anatomy and its clinical implications.Plast Reconstr Surg,2015,135(4):1097-1107.
22 蔡志刚,孙坚.显微外科技术在口腔颌面及头颈部修复与重建中的应用.中华显微外科杂志,2014,37(5):417-420.
23 Taylor GI,Gorlett RJ,Dhar SC,et al.The anatomical(angiosome)and clinical territories of cutaneous perforating arteries:developent of the concept and designing safe flap.Plast Resonstr Surg,2011,127(4):1447-1459.
24 陈丹,杨凯,陈睿,等.股前外侧皮瓣在口腔颌面部肿瘤术后缺损修复中的应用.重庆医科大学学报,2014,39(1):125-126.
25 肖海涛,时莹瑜,王怀胜,等.高频彩色多普勒超声检测穿支血管在股前外侧皮瓣手术中的应用.中国修复重建外科杂志,2013,27(2):178-181.
26 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.中华显微外科杂志,2015,38(1):20-24.
2 王金龙,徐斌,王兵,等.髂腹股沟皮瓣联合带蒂股前外侧皮瓣修复手部大面积皮肤缺损.重庆医学,2013,42(2):197-198.
3 陈睿,李雯娟,杨凯,等.股前外侧皮瓣在口腔颌面外科的临床应用.重庆医科大学学报,2014,39(8):1160-1162.
4 徐立群,张陈平,张志愿,等.血管化游离组织瓣在口腔颌面-头颈部缺损修复中的应用(4640例临床分析).实用肿瘤杂志,2015,30(1):18-21.
5 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.实用手外科杂志,2013,27(2):118-120.
6 Yamada S,Okamoto H,Sekiya I,et al.Anatomical basis of distally based anterolateral thigh flap.J Plast Surg Hand Surg,2014,48(3):197-200.
7 Wei ZR,Sun GF,Wang DL,et al.Reconstruction of the Achilles tendon and overlying skin defect:3 case reports.Ann Plast Surg,2014,73(3):325-329.
8 Zhuang Y,Hu S,Wu D,et al.A novel in vivo technique for observations of choke vessels in a rat skin flap model.Plast Reconstr Surg,2012,130(2):308-317.
9 Ao M,Asagoe K,Maeta M.Combined anterior thigh flaps and vascularized fibular graft for reconstruction of massive composite oromandibular defects.Br J Plast Surg,1998,51(5):350-355.
10 Singh B,Cordeiro PG,Santamaria E,et al.Factors associated with complications in microvascular reconstruction of head and neck defects.Plast Reconstr Surg,1999,103(2):403-411.
11 Yu P.Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction.Head Neck,2004,26(9):759-769.
12 Rogers SN,Lowe D.The University of Washington Quality of Life Scale//Handbook of Disease Burdens and Quality of Life Measures.New York:Springer,2010:101-128.
13 罗瑞华,齐金星,赵铭,等.削薄股前外侧皮瓣游离移植修复舌癌术后缺损的临床疗效.武汉大学学报(医学版),2012,33(4):585-586,593.
14 唐修俊,魏在荣,王波,等.游离旋股外侧动脉穿支KISS皮瓣修复四肢创面的临床应用.中华显微外科杂志,2015,38(1):29-32.
15 Hallock GG.Simultaneous transposition of anterior thigh muscle and fascia flaps:an introduction to the chimera flap principle.Ann Plast Surg,1991,27(2):126-131.
16 杜学亮,陈平,杜永军,等.串联皮瓣修复大面积颅骨外露.中国美容医学,2012,21(3):360-362.
17 徐中飞,代炜,张恩礁,等.股前外侧穿支嵌合皮瓣修复头颈肿瘤根治术后缺损.上海口腔医学,2012,21(1):107-112.
18 陈洁,蒋灿华,闵安杰,等.旋髂深动脉穿支嵌合髂骨皮瓣修复下颌骨复合性缺损.华西口腔医学杂志,2015,33(3):276-280.
19 Bhadkamkar MA,Wolfswinkel EM,Hatef DA,et al.The ultrathin,fascia-only anterolateral thigh flap.J Reconstr Microsurg,2014,30(9):599-606.
20 Goel S,Arora J,Mehta V,et al.Unusual disposition of lateral circumflex femoral artery:Anatomical description and clinical implications.World J Clin Cases,2015,3(1):85-88.
21 Lee YC,Chen WC,Chou TM,et al.Anatomical variability of the anterolateral thigh flap perforators:vascular anatomy and its clinical implications.Plast Reconstr Surg,2015,135(4):1097-1107.
22 蔡志刚,孙坚.显微外科技术在口腔颌面及头颈部修复与重建中的应用.中华显微外科杂志,2014,37(5):417-420.
23 Taylor GI,Gorlett RJ,Dhar SC,et al.The anatomical(angiosome)and clinical territories of cutaneous perforating arteries:developent of the concept and designing safe flap.Plast Resonstr Surg,2011,127(4):1447-1459.
24 陈丹,杨凯,陈睿,等.股前外侧皮瓣在口腔颌面部肿瘤术后缺损修复中的应用.重庆医科大学学报,2014,39(1):125-126.
25 肖海涛,时莹瑜,王怀胜,等.高频彩色多普勒超声检测穿支血管在股前外侧皮瓣手术中的应用.中国修复重建外科杂志,2013,27(2):178-181.
26 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.中华显微外科杂志,2015,38(1):20-24.