CTA辅助游离股前外侧肌皮瓣修复舌癌术后缺损的应用研究
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摘要
目的:探讨CTA(CT血管造影)对指导游离股前外侧肌皮瓣制备的辅助价值及该皮瓣在舌癌术后缺损修复中的临床效果。方法:对17例明确诊断为舌鳞形细胞癌的患者,术前采用CTA辅助定位旋股外侧动脉降支的穿支血管,选取以该穿支血管为蒂的股前外侧肌皮瓣游离移植修复舌癌术后软组织缺损。结果:所有患者术前CTA辅助定位穿支血管的皮瓣制备在术中按计划均获成功,游离移植肌皮瓣全部存活。术后随访6～36个月,患者舌体形态、功能恢复良好,无明显吞咽及言语功能障碍,局部未见肿瘤复发,供瓣肢无功能障碍。其中1例(T_4N_2M_0)于术后12个月合并肝、肺转移后死亡。结论:CTA辅助定位旋股外侧动脉穿支血管的方法可靠、实用,游离股前外侧肌皮瓣是修复舌癌术后软组织缺损较为理想的选择。
Objective The aim of the study was to investigate the auxiliary value of computed tomography angiography(CTA) in assisting the preparation of free anterolateral thigh myocutaneous flap(ALTMF) and the clinical effect of ALTMF for the reconstruction of postoperative defects after radical resection of tongue carcinoma. Methods CTA were used to locate the perforating vessel of lateral circumflex femoral artery(LCFA) in all cases who were diagnosed as tongue carcinoma, postoperative defects were reconstructed with the flap which depended on the perforating vessel of LCFA. Results The preparation of preoperative CTA achieved success as plan and survived completely in all cases. All patients were followed up 6-36 months, There was no functional morbidity in donor sites and local recurrence happened. The shape and function of all cases were both satisfactory in reconstructed tongue. Only one case(T_4N_2M_0) died of liver and lung metastasis 12 months after operation. Conclusion The method of CTA assisted to locate the perforating vessel of ALTMF is reliable and practical. The ALTMF is an ideal choice for the reconstruction of postoperative defects after radical resection of tongue carcinoma.
Objective The aim of the study was to investigate the auxiliary value of computed tomography angiography(CTA) in assisting the preparation of free anterolateral thigh myocutaneous flap(ALTMF) and the clinical effect of ALTMF for the reconstruction of postoperative defects after radical resection of tongue carcinoma. Methods CTA were used to locate the perforating vessel of lateral circumflex femoral artery(LCFA) in all cases who were diagnosed as tongue carcinoma, postoperative defects were reconstructed with the flap which depended on the perforating vessel of LCFA. Results The preparation of preoperative CTA achieved success as plan and survived completely in all cases. All patients were followed up 6-36 months, There was no functional morbidity in donor sites and local recurrence happened. The shape and function of all cases were both satisfactory in reconstructed tongue. Only one case(T_4N_2M_0) died of liver and lung metastasis 12 months after operation. Conclusion The method of CTA assisted to locate the perforating vessel of ALTMF is reliable and practical. The ALTMF is an ideal choice for the reconstruction of postoperative defects after radical resection of tongue carcinoma.
引文
[1]常虹.游离皮瓣移植修复口腔颌面部缺损的临床效果观察[J].中国美容医学,2017,26(5):101-103.
[2]李小东,封兴华,魏建华,等.股前外侧组织瓣在口腔颌面部软组织缺损中的应用[J].中国美容医学,2009,18(9):1279-1280.
[3]Wu CC,Lin PY,Chew KY,et al.Free tissue transfers in head and neck reconstruction:complications,outcomes and strategies for management of flap failure:analysis of 2019 flaps in single institute[J].Microsurgery,2014,34(5):339-344.
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[7]李静言,付光新,胡运桃,等.口腔颌面部全麻手术患者安置胃管时机的探讨[J].海南医学,2014,25(2):309-311.
[8]孙姝玲,佘小伟.应用前臂游离皮瓣修复舌癌根治术后创面的护理[J].中国美容医学,2016,25(4):82-83.
[9]吴双江,夏德林,明华伟,等.修薄的股前外侧皮瓣修复颊癌术后缺损[J].中华整形外科杂志,2016,32(5):339-342.
[10]万冠群,巫国辉,李小林.口腔颌面部肿瘤术后组织缺损修复的临床研究[J].中国美容医学,2015,24(6):24-27.
[11]李建虎,孙沫逸,郑军,等.改良前臂皮瓣在舌和口底联合缺损修复中的应用[J].中国美容医学,2010,19(10):1476-1478.
[12]孙黎波,肖金刚,夏德林,等.薄型游离股前外侧皮瓣修复舌癌术后缺损[J].广东医学,2015,36(10):1573-1575.
[13]De Vicente J C,De Villalain L,Torre A,et al.Microvascular free tissue transfer for tongue reconstruction after hemiglossectomy:a functional assessment of radial forearm versus anterolateral thigh flap[J].J Oral Maxillofac Surg,2008,66(11):2270-2275.
[14]夏德林,付光新,马征,等.游离股前外侧肌皮瓣在舌癌术后缺损修复与舌再造中的应用[J].中华整形外科杂志,2011,27(1):8-11.
[15]Sun G,Lu M,Tang E,et al.Clinical application of free anterolateral thigh flap in the reconstruction of intraoral defects[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2011,112(1):34-41.
[16]段家章,何晓清,徐永清.股前外侧皮瓣血管解剖学及术前皮瓣设计技术研究进展[J].中国修复重建外科杂志,2016,30(7):909-914.
[17]Mathes DW,Neligan PC.Preoperative imaging techniques for perforator selection in abdomen-based microsurgical breast reconstruction[J].Clin Plast Surg,2010,37(4):581-591.
[18]饶鹏程,罗世洪,王雷,等.CT血管造影辅助设计的个性化股前外侧皮瓣在修复舌癌术后缺损中的应用[J].实用口腔医学杂志,2017,33(5):625-629.
[19]庄跃宏,徐达传,唐茂林.CT血管造影在皮瓣外科的研究进展[J].中国临床解剖学杂志,2010,28(4):469-472.
[20]Gangiti KK,Gondi JT,Nemade H,et al.Modified pectoralis major myocutaneous flap for the total glossectomy defects:Effect on quality of life[J].J Surg Oncol,2016,114(1):32-35.
[21]Yuan Y,Zhang P,He W,et al.Comparison of oral Function:free anterolateral thigh perforator flaps versus vascularized free forearm flap for reconstruction in patients undergoing glossectomy[J].J Oral Maxillofac Surg,2016,74(7):1500-1501.
[22]董科,邵益森,习伟宏,等.两种皮瓣修复舌癌术后缺损患者对其生存质量的影响比较[J].实用医学杂志,2016,32(21):3585-3588.
[23]田皞,李赞,喻建军,等.CTA并三维重建技术在指导游离股前外侧皮瓣制备中的应用[J].现代肿瘤医学,2016,24(3):375-379.
[24]朱洪章,杨有优,范淼,等.CT血管造影在旋股外侧动脉3D可视化与穿支体表导航定位中的应用[J].中华显微外科杂志,2013,36(3):287-291.
[2]李小东,封兴华,魏建华,等.股前外侧组织瓣在口腔颌面部软组织缺损中的应用[J].中国美容医学,2009,18(9):1279-1280.
[3]Wu CC,Lin PY,Chew KY,et al.Free tissue transfers in head and neck reconstruction:complications,outcomes and strategies for management of flap failure:analysis of 2019 flaps in single institute[J].Microsurgery,2014,34(5):339-344.
[4]Satish C,Baliarsing A.Variations in perforators of anterolateral thigh flap[J].Eur J Plast Surg,2012,35(1):77-79.
[5]Lee YC,Chen WC,Chou TM,et al.Anatomical variability of the anterolateral thigh flap perforators:vascular anatomy and its clinical implications[J].Plast Reconstr Surg,2015,135(4):1097-1107.
[6]马征,吴双江,肖鸣,等.股前外侧游离皮瓣在舌癌术后缺损修复重建中的应用[J].广东医学,2013,34(19):3003-3005.
[7]李静言,付光新,胡运桃,等.口腔颌面部全麻手术患者安置胃管时机的探讨[J].海南医学,2014,25(2):309-311.
[8]孙姝玲,佘小伟.应用前臂游离皮瓣修复舌癌根治术后创面的护理[J].中国美容医学,2016,25(4):82-83.
[9]吴双江,夏德林,明华伟,等.修薄的股前外侧皮瓣修复颊癌术后缺损[J].中华整形外科杂志,2016,32(5):339-342.
[10]万冠群,巫国辉,李小林.口腔颌面部肿瘤术后组织缺损修复的临床研究[J].中国美容医学,2015,24(6):24-27.
[11]李建虎,孙沫逸,郑军,等.改良前臂皮瓣在舌和口底联合缺损修复中的应用[J].中国美容医学,2010,19(10):1476-1478.
[12]孙黎波,肖金刚,夏德林,等.薄型游离股前外侧皮瓣修复舌癌术后缺损[J].广东医学,2015,36(10):1573-1575.
[13]De Vicente J C,De Villalain L,Torre A,et al.Microvascular free tissue transfer for tongue reconstruction after hemiglossectomy:a functional assessment of radial forearm versus anterolateral thigh flap[J].J Oral Maxillofac Surg,2008,66(11):2270-2275.
[14]夏德林,付光新,马征,等.游离股前外侧肌皮瓣在舌癌术后缺损修复与舌再造中的应用[J].中华整形外科杂志,2011,27(1):8-11.
[15]Sun G,Lu M,Tang E,et al.Clinical application of free anterolateral thigh flap in the reconstruction of intraoral defects[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2011,112(1):34-41.
[16]段家章,何晓清,徐永清.股前外侧皮瓣血管解剖学及术前皮瓣设计技术研究进展[J].中国修复重建外科杂志,2016,30(7):909-914.
[17]Mathes DW,Neligan PC.Preoperative imaging techniques for perforator selection in abdomen-based microsurgical breast reconstruction[J].Clin Plast Surg,2010,37(4):581-591.
[18]饶鹏程,罗世洪,王雷,等.CT血管造影辅助设计的个性化股前外侧皮瓣在修复舌癌术后缺损中的应用[J].实用口腔医学杂志,2017,33(5):625-629.
[19]庄跃宏,徐达传,唐茂林.CT血管造影在皮瓣外科的研究进展[J].中国临床解剖学杂志,2010,28(4):469-472.
[20]Gangiti KK,Gondi JT,Nemade H,et al.Modified pectoralis major myocutaneous flap for the total glossectomy defects:Effect on quality of life[J].J Surg Oncol,2016,114(1):32-35.
[21]Yuan Y,Zhang P,He W,et al.Comparison of oral Function:free anterolateral thigh perforator flaps versus vascularized free forearm flap for reconstruction in patients undergoing glossectomy[J].J Oral Maxillofac Surg,2016,74(7):1500-1501.
[22]董科,邵益森,习伟宏,等.两种皮瓣修复舌癌术后缺损患者对其生存质量的影响比较[J].实用医学杂志,2016,32(21):3585-3588.
[23]田皞,李赞,喻建军,等.CTA并三维重建技术在指导游离股前外侧皮瓣制备中的应用[J].现代肿瘤医学,2016,24(3):375-379.
[24]朱洪章,杨有优,范淼,等.CT血管造影在旋股外侧动脉3D可视化与穿支体表导航定位中的应用[J].中华显微外科杂志,2013,36(3):287-291.