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目的探讨上臂外侧皮瓣和前臂皮瓣修复口腔癌术后组织缺损患者的临床效果比较。方法选取2014年4月至2015年7月在沈阳市第五人民医院修复口腔癌术后组织缺损的患者68例为研究对象,根据手术方式不同分为研究组与对照组,每组34例。研究组患者实施上臂外侧皮瓣修复口腔癌术后组织缺损,对照组患者实施前臂皮瓣修复口腔癌术后组织缺损,记录两组患者的手术时间和成功率,术后随访6个月,记录患者口腔功能恢复情况,术中及术后严密观察并发症发生情况。结果研究组患者行上臂外侧皮瓣制备手术,平均用时(46±7)min,对照组患者行前臂皮瓣制备手术,平均用时(44±8)min,两组比较,差异无统计学意义(P>0.05)。研究组中失败1例导致术后皮瓣坏死,手术成功率为97.1%(33/34);对照组中失败2例导致术后皮瓣坏死,手术成功率为94.1%(32/34),两组患者手术成功率比较,差异无统计学意义(P>0.05)。术后患者随访率为100%,所有患者恢复良好,均能经口进软食和普食,张口咀嚼正常,主观判听无发音不准,两组患者术后各1例发生出血血管危象,冲洗调整更换引流管后好转,研究组1例臂后外侧局部轻微麻木,并发症发生率为5.9%(2/34);对照组1例桡侧皮神经损伤,并发症发生率为5.9%(2/34),两组并发症发生率差异无统计学意义(P>0.05)。结论上臂外侧皮瓣解剖恒定、血供丰富、手术操作难度相对较小,皮瓣厚度适宜,是一种更理想的口腔癌术后软组织缺损修复选择。
Objective To investigate the clinical effects of the flaps and forearm flaps of the upper arm in the repair of postoperative tissue defects of oral cancer. Methods From April 2014 to July 2015, 68 patients with tissue defect after oral cancer repair in the Fifth People’s Hospital of Shenyang were enrolled in this study. The patients were divided into study group and control group with 34 cases in each group. In the study group, the lateral flap of the upper arm was used to repair the postoperative tissue defect in oral cancer. The control group was treated with forearm flap to repair the postoperative tissue defect of oral cancer. The operation time and success rate of the two groups were recorded. The patients were followed up for 6 months, Patients with oral function recovery, intraoperative and postoperative close observation of complications. Results In the study group, the lateral superior arm flap was used for surgery, the average time was (46 ± 7) min. The control group was operated on forearm flap for a mean time of (44 ± 8) min. There was no significant difference between the two groups P> 0.05). One case failed in the study group, which resulted in postoperative flap necrosis. The success rate of operation was 97.1% (33/34). Two cases failed in the control group, which resulted in postoperative flap necrosis. The successful rate was 94.1% (32/34) There was no significant difference between the two groups in the success rate of surgery (P> 0.05). Postoperative follow-up rate of 100%, all patients recovered well, both by mouth into the soft food and general diet, mouth chewing normal, subjective verdicts without pronunciation are not allowed, two cases of postoperative bleeding hemorrhage crisis, Flush adjusted to replace the drainage tube improved, the study group, 1 case of posterolateral slightly numbness, the complication rate was 5.9% (2/34); control group, 1 case of radial nerve injury, the incidence of complications was 5.9% ( 2/34). There was no significant difference in the incidence of complications between the two groups (P> 0.05). Conclusions The lateral flap of the upper arm is of constant anatomy, abundant blood supply, relatively small operation difficulty and suitable thickness of flap, which is a better choice for postoperative soft tissue defect repair of oral cancer.