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目的比较血管化下段胸锁乳突肌皮瓣和颏下岛状皮瓣在头颈部肿瘤术后口腔颌面部缺损一期修复的临床效果。方法 63例头颈部鳞癌术后口腔颌面部缺损采用血管化下段胸锁乳突肌皮瓣(A组,28例)或颏下岛状皮瓣(B组,35例)修复,分析两组的临床资料,比较两组皮瓣面积、制取时间、血管蒂长、皮瓣成活率和局部并发症。结果 A组皮瓣面积小于B组[(32.1±11.7)cm2vs.(54.2±20.4)cm2](P<0.05)。A、B两组皮瓣血管蒂长相仿[(7.9±1.0)cm vs.(8.1±1.1)cm](P>0.05);两组皮瓣制取时间无统计学差异[(58.9±5.3)min vs.(56.8±5.4)min](P>0.05)。A、B两组皮瓣成活率均很高[96.4%(27/28)vs.97.1%(34/35)](P>0.05)。A组有1例口底癌患者皮瓣坏死,甲状腺上动脉内血栓形成,后改用胸大肌皮瓣修复。B组有1例因为术区感染导致皮瓣部分坏死,后经术区换药后瘢痕愈合。两组皮瓣局部并发症发生情况相仿(P>0.05)。结论血管化下段胸锁乳突肌皮瓣和颏下岛状皮瓣各具有优缺点及适应证,均适用于头颈部恶性肿瘤患者术后缺损修复,成活率高。
Objective To compare the clinical efficacy of the first stage repair of oral and maxillofacial defects after vascularized lower sternocleidomastoid flap and submental island flap in head and neck cancer. Methods Sixty-three patients with head and neck squamous cell carcinoma were treated with vascularized lower sternocleidomastoid flap (group A, n = 28) or submental island flap (group B, n = 35) Two groups of clinical data, the two groups of flap area, preparation time, vascular pedicle length, flap survival rate and local complications. Results The area of flap in group A was smaller than that in group B [(32.1 ± 11.7) cm2 vs (54.2 ± 20.4) cm2] (P <0.05). There was no significant difference in flap length between the two groups ([(7.9 ± 1.0) cm vs (8.1 ± 1.1) cm] [(58.9 ± 5.3) min vs. (56.8 ± 5.4) min] (P> 0.05). The survival rates of flaps in both groups were high [96.4% (27/28) vs 97.1% (34/35)] (P> 0.05). In group A, there was a case of flap necrosis in the mouth of the mouth cancer, thrombosis in the thyroid artery, and then the flap of the pectoralis major muscle was repaired. One patient in group B had partial necrosis of the flap due to infection in the operation area, and the scar healed after the dressing was changed in the operation area. The incidence of local complications in the two groups was similar (P> 0.05). Conclusion The vascularized lower sternocleidomastoid flap and submental island flap have advantages and disadvantages and indications, which are both suitable for the repair of postoperative defects in patients with head and neck malignant tumor with high survival rate.