论文部分内容阅读
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 curative effect of anterolateral femoral skin flap and tandem skin flap in the repair of postoperative radical mastectomy of oral and maxillofacial region. Methods From January 2011 to July 2014, 39 patients (chimeric flap group) with 39 patients who undergone resection of oral and maxillofacial neoplasms with anterior anterolateral chimeric skin flap were retrospectively analyzed. The clinical data of the patients were collected from January 2009 to July 2010 In December of the year, 35 patients (tandem skin flap group) were treated with free skin flaps in series as a control. There was no significant difference between the two groups in general data such as sex, age, course of disease, tumor type, tumor stage, extent of defect and site, etc. (P> 0.05). Record and compare the operation time, flap production and time of microscopic anastomosis, the time of gastric tube removal, the time of oral feeding, and the occurrence of complications. After the reconstruction of the bone and soft tissue defect Evaluation of efficacy (Washington University’s quality of life scale) evaluation of efficacy. Results Two cases of chimeric skin flap and 4 flap skin flap showed vascular crisis. One flap of tandem skin flap showed partial necrosis at the distal end of the flap, and three flaps in the tandem skin flap group presented submandibular Fistula and infection; other patients flap successfully survived, wound healing by district Ⅰ. Skin grafts for the district were successfully survived, incision healed. The chimeric flap operation time, gastric tube removal time, oral feeding time were significantly less than the serial flap group, flap production and microscopic anastomosis longer than the control group, the difference was statistically significant (P <0.05 ). Two groups of patients were followed up for 1 to 5 years, an average of 2.5 years. At 3 months after operation, according to the evaluation of clinical curative effect after reconstruction of bone and soft tissue defect after radical operation of oral and maxillofacial tumors, the appearance, patient satisfaction, working condition, oral closure function, chewing and language expression of chimeric flap group , Swallowing score were significantly higher than the series flap group (P <0.05). There was no significant difference in diet, mouth opening, mouth water content and bite score (P> 0.05). Conclusions Compared with tandem skin flap, the anterolateral femoral skin flap can repair the postoperative defect of oral and maxillofacial tumor, shorten the operation time and speed up postoperative rehabilitation. It is also beneficial to patients with postoperative oral closure, chewing, language and swallowing recovery .