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目的探讨股前外侧肌皮瓣在腹股沟淋巴结清扫术中的应用对腹股沟淋巴结清扫术后的淋巴管瘘、切口感染及皮肤坏死等并发症的影响,为临床预防腹股沟淋巴结清扫的术后感染提供依据。方法对2005年8月至2013年7月,我科收治的下肢恶性黑色素瘤患者73例均行腹股沟淋巴结清扫术。其中行常规腹股沟淋巴结清扫术的33例为对照组;行腹股沟淋巴结清扫术联合应用股前外侧肌皮瓣移植的40例为实验组。对2组术后的淋巴管瘘、切口感染及皮肤坏死等情况进行随访和比较,并观察术后皮瓣情况。结果73例均获随访,随访时间为6个月至2年,中位随访时间1年。实验组中发生术后淋巴管瘘3例(7.5%)、切口感染1例(2.5%)、皮肤坏死2例(5.0%);而对照组中发生术后淋巴管瘘12例(36.4%)、切口感染10例(30.3%)、皮肤坏死11例(33.1%);且实验组淋巴管瘘、切口感染、皮肤坏死的发生率均明显小于对照组,差异有统计学意义(P<0.05)。术后1个月,皮瓣色泽红润、皮温正常、质地柔软、未见红肿及流血流脓。结论腹股沟淋巴结清扫术中应用股前外侧肌皮瓣能有效减轻腹股沟淋巴结清扫术后的淋巴管瘘、切口感染及皮肤坏死等并发症的发生,对临床预防腹股沟淋巴结清扫的术后感染起积极作用。
Objective To investigate the effect of anterolateral myocutaneous flap in the treatment of inguinal lymph node dissection on the complications of lymphatic fistula, incision infection and skin necrosis after inguinal lymphadenectomy and to provide basis for clinical prevention of postoperative infection of inguinal lymph node dissection . Methods From August 2005 to July 2013, 73 patients with malignant melanoma of lower extremity treated in our department underwent inguinal lymphadenectomy. Among them, 33 cases underwent conventional inguinal lymphadenectomy as the control group; 40 cases underwent inguinal lymphadenectomy combined with anterolateral myocutaneous flap transplantation for the experimental group. The postoperative lymphatic fistula, incision infection and skin necrosis were followed up and compared, and the postoperative flap was observed. Results All the 73 cases were followed up for 6 months to 2 years with a median follow-up of 1 year. There were 3 cases (7.5%) of postoperative lymphatic fistula, 1 case (2.5%) incisional wound infection and 2 cases of skin necrosis (5.0%) in the experimental group. Twelve cases (36.4%) of postoperative lymphatic fistula occurred in the control group, , Incision infection in 10 cases (30.3%) and skin necrosis in 11 cases (33.1%). The incidences of lymphatic fistula, incision infection and skin necrosis in the experimental group were significantly less than those in the control group (P <0.05) . One month after operation, the flap color is rosy, the skin temperature is normal, the texture is soft, no redness and bleeding pus are found. Conclusion The application of anterolateral myocutaneous flaps in inguinal lymphadenectomy can effectively reduce the occurrence of complications such as lymphatic fistula, incision infection and skin necrosis after inguinal lymphadenectomy, and plays an active role in postoperative infection prevention of inguinal lymph node dissection .