本文選題：股前外側(cè)嵌合皮瓣 + 串聯(lián)皮瓣��； 參考：《中國修復(fù)重建外科雜志》2016年04期

【摘要】：目的比較股前外側(cè)嵌合皮瓣及串聯(lián)皮瓣修復(fù)口腔頜面部腫瘤根治術(shù)后缺損的療效。方法回顧分析2011年1月-2014年7月39例采用股前外側(cè)嵌合皮瓣修復(fù)口腔頜面部腫瘤根治術(shù)后缺損患者(嵌合皮瓣組)臨床資料,以2009年1月-2010年12月采用串聯(lián)游離皮瓣修復(fù)的35例患者(串聯(lián)皮瓣組)作為對照。兩組患者性別、年齡、病程、腫瘤類型、腫瘤分期及缺損范圍、部位等一般資料比較,差異均無統(tǒng)計學(xué)意義(P0.05),具有可比性。記錄并比較兩組手術(shù)時間、皮瓣制作及顯微吻合時間、拔除胃管時間、開始經(jīng)口進(jìn)食時間,觀察并發(fā)癥發(fā)生情況;參照口腔頜面腫瘤根治術(shù)后骨與軟組織缺損修復(fù)重建后臨床療效評估表(華盛頓大學(xué)生存質(zhì)量量表)評價療效。結(jié)果術(shù)后嵌合皮瓣組2例、串聯(lián)皮瓣組4例皮瓣出現(xiàn)血管危象,串聯(lián)皮瓣組1例皮瓣遠(yuǎn)心端出現(xiàn)部分壞死,串聯(lián)皮瓣組3例出現(xiàn)口底頜下瘺和感染;其余患者皮瓣順利成活,受區(qū)創(chuàng)面Ⅰ期愈合。供區(qū)植皮均順利成活,切口Ⅰ期愈合。嵌合皮瓣組手術(shù)時間、拔除胃管時間、開始經(jīng)口進(jìn)食時間均顯著少于串聯(lián)皮瓣組,皮瓣制作及顯微吻合時間長于對照組,比較差異均有統(tǒng)計學(xué)意義(P0.05)。兩組患者均獲隨訪,隨訪時間1~5年,平均2.5年。術(shù)后3個月,根據(jù)口腔頜面腫瘤根治術(shù)后骨與軟組織缺損修復(fù)重建后臨床療效評估表,嵌合皮瓣組術(shù)后外形、患者滿意度、工作狀況、口腔閉合功能、咀嚼、語言表達(dá)、吞咽評分均顯著高于串聯(lián)皮瓣組(P0.05);飲食、張口度、口腔容納水測試及咬合評分比較,差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論與串聯(lián)皮瓣相比,股前外側(cè)嵌合皮瓣修復(fù)口腔頜面部腫瘤術(shù)后缺損能縮短手術(shù)時間、加快術(shù)后康復(fù),同時有利于患者術(shù)后口腔閉合、咀嚼、語言、吞咽功能恢復(fù)。
[Abstract]:Objective to compare the efficacy of anterolateral femoral flap and series flap in repairing oral and maxillofacial tumor defects. Methods from January 2011 to July 2014, 39 patients with oral and maxillofacial tumor defects (chimeric flap group) were treated with anterolateral femoral chimeric flap. From January 2009 to December 2010, 35 patients (series flap group) were treated with series free flap as control group. There were no significant differences in sex, age, course of disease, tumor type, tumor stage, defect area and location between the two groups, and there was no significant difference between the two groups (P 0.05). The operation time, the time of flap fabrication and microanastomosis, the time of removing gastric tube and the time of feeding through mouth were recorded and compared between the two groups, and the complications were observed. To evaluate the clinical efficacy of bone and soft tissue defect reconstruction after radical resection of oral and maxillofacial tumors (University of Washington quality of Life scale). Results there were 2 cases in the chimeric flap group, 4 cases in the series flap group, 1 case in the series flap group with partial necrosis at the distal end of the flap, 3 cases with submaxillary fistula and infection in the series flap group. The wound of recipient area was healed in the first stage. The donor skin grafts survived successfully and the incision healed in the first stage. In the chimeric flap group, the time of operation, extraction of gastric tube and beginning of oral feeding were significantly shorter than those in the series flap group, and the time of flap fabrication and microanastomosis was longer than that of the control group, and the difference was statistically significant (P 0.05). The patients in both groups were followed up for 1 ~ 5 years (mean 2.5 years). 3 months after operation, according to the clinical evaluation table of bone and soft tissue defect reconstruction after radical resection of oral and maxillofacial tumor, the postoperative appearance, patient satisfaction, work status, oral closure function, mastication and language expression of chimeric flap group were analyzed. The score of swallowing was significantly higher than that of the series flap group (P 0.05), but there was no significant difference in diet, mouth opening, oral water inclusion test and occlusal score. Conclusion compared with the series flaps, the repair of oral and maxillofacial tumor defects by the anterolateral femoral chimeric flap can shorten the operative time and accelerate the postoperative recovery. It is also beneficial to the recovery of oral cavity closure, mastication, language and swallowing after operation.
【作者單位】： 湘潭市中心醫(yī)院口腔頜面外科;
【基金】：湘潭市科技計劃資助項目(ZJ20131018)~~
【分類號】：R739.8

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