本文選題：頰脂墊　切入點(diǎn)：脫細(xì)胞真皮基質(zhì)　出處：《安徽醫(yī)科大學(xué)》2015年碩士論文

【摘要】：背景口腔頜面部軟組織可發(fā)生不同類型病變,頰黏膜是病灶常見發(fā)生處,治療方法多樣,包括藥物及手術(shù)切除等。而病灶切除后造成的軟組織缺損不僅影響美觀,同時可因不同程度張口受限而產(chǎn)生咀嚼及言語等功能障礙。臨床上對頰黏膜軟組織缺損的重建包括直接拉攏縫合、黏膜轉(zhuǎn)移、自體頰脂墊移植[1]、中厚皮片移植和血管吻合游離皮瓣移植等方法。近年來脫細(xì)胞真皮基質(zhì)(acellular dermal matrix.ADM)已被臨床工作者大量應(yīng)用,在修補(bǔ)軟組織缺損方面取得了理想的手術(shù)效果[2]。ADM是由同種或異種真皮組織經(jīng)過特殊處理,去除其細(xì)胞成分后得到的一種真皮替代品。同種ADM來源于死刑犯,由于倫理方面的限制,使用日益見少;現(xiàn)臨床上以異種ADM為主,其使用哺乳動物(如牛、豬等)的皮膚制備而成,用于修復(fù)口腔黏膜缺損是安全和有效的,是一種較為理想的真皮替代物。目的觀察并比較自體帶蒂頰脂墊瓣(pedicle buccal fat pad flap,PBFPF)與ADM在修復(fù)頰黏膜缺損中的臨床效果。方法選取我院口腔頜面外科2012年12月~2013年12月因口腔頰部良惡性腫瘤需手術(shù)治療者46例,其中男25例,女21例。所有病例中乳頭狀瘤7例、脈管畸形14例、脂肪瘤4例、多形性腺瘤9例、白斑2例、黏膜下纖維化2例、創(chuàng)傷性潰瘍1例、未浸及肌層鱗癌3例(T1N0M0期1例、T2N0M0期2例,UICC 2010版),未浸及肌層低度惡性黏液表皮樣癌4例(T1N0M0期,UICC 2010版)。面積2.3 cm×3.7 cm~4.2 cm×5.1 cm,均不能直接拉攏縫合。將46例患者隨機(jī)分為2組,一組使用PBFPF修復(fù)手術(shù)后頰黏膜缺損,另一組在切除術(shù)區(qū)病損后,表面縫蓋ADM。觀察并記錄兩組患者術(shù)前及術(shù)后1~6個月最大開口度(maximum opening degree,MMO)、手術(shù)修復(fù)時間等并結(jié)合患者滿意度進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果兩組組織瓣術(shù)后均成活,未見明顯血腫、感染、局部壞死、過度瘢痕及面神經(jīng)受損等。PBFPF組術(shù)后1~3天MMO均低于ADM組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),而術(shù)后1周至6個月兩組MMO相比差異無統(tǒng)計(jì)學(xué)意義;兩者手術(shù)修復(fù)時間相比,差異有統(tǒng)計(jì)學(xué)意義(P0.05);比較兩組患者滿意度,差異無統(tǒng)計(jì)學(xué)意義。結(jié)論兩種方法均可滿足頰部良性腫瘤及口腔中后部T2N0M0惡性腫瘤初次治療要求,ADM使用更加靈活。但受病例數(shù)限制,對于首次切除T2N0M0及以下惡性腫瘤首選ADM修復(fù)是否合適,還需進(jìn)一步研究。
[Abstract]:Background different types of soft tissue lesions can occur in oral and maxillofacial regions, buccal mucosa is the common location of lesions, and there are various treatment methods, including drugs and surgical excision.The soft tissue defects caused by excision not only affect the beauty, but also cause chewing and speech disorders due to the limited opening of mouth.Clinical reconstruction of buccal mucosal soft tissue defects includes direct suture, mucosal metastasis, buccal fat pad autograft, moderate thickness skin graft and free vascular anastomosis flap transplantation.Acellular dermal matrix. ADM has been widely used by clinical workers in recent years. It has achieved ideal surgical results in repairing soft tissue defects [2] .ADM is specially treated by allogeneic or xenogeneic dermal tissue.A dermal substitute obtained by removing its cellular components.ADM of the same species, derived from death row prisoners, is used less and less because of ethical restrictions. Now it is mainly heterologous ADM, which is prepared from the skin of mammals (such as cattle, pigs, etc.).It is safe and effective to repair oral mucosal defects and is an ideal dermal substitute.Objective to observe and compare the clinical effects of buccal buccal pad flapfps and ADM in repairing buccal mucosal defects.Methods from December 2012 to December 2013, 46 patients (25 males and 21 females) with benign and malignant tumors of buccal region in our hospital were selected.There were 7 cases of papilloma, 14 cases of vascular malformation, 4 cases of lipoma, 9 cases of pleomorphic adenoma, 2 cases of leukoplakia, 2 cases of submucosal fibrosis and 1 case of traumatic ulcer.There were 3 cases of uninfiltrated myosquous squamous cell carcinoma (T1N0M0), 1 case of T1N0M0 stage and 2 cases of T2N0M0 stage (UICC 2010), and 4 cases of myometrium low grade malignant mucoepidermoid carcinoma (MECC) were diagnosed as T1N0M0 stage (UICC 2010).The area was 2. 3 cm 脳 3. 7 cm~4.2 cm 脳 5. 1 cm, all of them could not be closed and sutured directly.46 patients were randomly divided into two groups: one group was treated with PBFPF to repair buccal mucosal defect, the other group was treated with PBFPF.The maximum opening degree before operation and 1 ~ 6 months after operation were observed and recorded, and the time of operation and repair were analyzed statistically.Results there was no obvious hematoma, infection, local necrosis, hyperscar and facial nerve injury in both groups. The MMO of PBFPF group was lower than that of ADM group on the 1st and 3rd day after operation.The difference was statistically significant (P 0.05), but there was no significant difference in MMO between the two groups from 1 week to 6 months after operation, there was significant difference in the time of operation and repair between the two groups (P 0.05), and there was no significant difference between the two groups in patient satisfaction.Conclusion both methods can meet the primary treatment requirements of benign buccal tumors and T2N0M0 tumors in the middle and posterior parts of the oral cavity.However, due to the limitation of the number of cases, it is necessary to further study whether the ADM repair is the first choice for the first excision of T2N0M0 and the following malignant tumors.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R782.2

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