本文選題：口腔癌 + 游離前臂皮瓣　； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]比較游離前臂皮瓣與頦下島狀瓣在修復(fù)口腔癌術(shù)后組織缺損中的即刻修復(fù)和功能重建,評(píng)價(jià)兩種皮瓣的臨床價(jià)值及其特點(diǎn)。[方法]收集昆明醫(yī)科大學(xué)附屬口腔醫(yī)院口腔頜面外科住院部自2013年6月-2016年9月以游離前臂皮瓣與頦下島狀瓣修復(fù)重建口腔癌術(shù)后組織缺損的49例病例。對(duì)49例口腔癌患者均行原發(fā)灶根治術(shù)并同期行游離前臂皮瓣或頦下島狀瓣即刻修復(fù)重建口腔癌切除術(shù)后組織缺損,其中行游離前臂皮瓣修復(fù)17例,頦下島狀瓣修復(fù)32例。通過利用SPSS21. 0分析比較兩組患者的術(shù)前一般資料、手術(shù)時(shí)間、術(shù)后滲出液總量、皮瓣成活率、皮瓣及游離皮片感染壞死率及患者滿意程度等情況。隨訪觀察患者受區(qū)、供區(qū)外形及功能恢復(fù)狀況,并通過華盛頓大學(xué)生存質(zhì)量問卷(UW-QOL)評(píng)價(jià)觀察患者術(shù)后生存質(zhì)量。[結(jié)果]通過SPSS21.0分析統(tǒng)計(jì)患者的術(shù)前資料顯示,兩組患者的性別、平均年齡、病理分級(jí)及隨訪時(shí)間基本相似,比較差異無統(tǒng)計(jì)學(xué)意義(P0. 05)。游離前臂皮瓣組手術(shù)時(shí)間為(493. 70±93. 42) min,頦下島狀瓣組手術(shù)時(shí)間為(314. 93±82. 76) min,游離前臂皮瓣組手術(shù)時(shí)間明顯高于頦下島狀瓣組,兩者之間存在顯著差異性(p 0.01);游離前臂皮瓣組術(shù)后滲出液量為(314. 70±125. 88) ml,頦下島狀瓣組術(shù)后滲出液量為(247. 31±102. 08) ml,游離前臂皮瓣組術(shù)后滲出液量明顯高于頦下島狀瓣組,兩者之間存在差異性,具有統(tǒng)計(jì)學(xué)意義(p 0.05);游離前臂皮瓣組皮瓣成活率為88.23% (15/17),低于頦下島狀瓣組的96.87% (31/32) (p0. 05);兩組患者的受區(qū)及供區(qū)感染壞死率比較:游離前臂皮瓣組為29. 41% (5/17),高于頦下島狀瓣組的3.12% (1/32),兩者之間存在差異性,具有統(tǒng)計(jì)學(xué)意義(p 0.05);兩組患者術(shù)后受區(qū)的外形及功能恢復(fù)情況基本相近,但對(duì)于術(shù)后供區(qū)統(tǒng)計(jì)顯示,游離前臂皮瓣組發(fā)生色素沉著、麻木感覺及暫時(shí)性的功能障礙的比率較頦下島狀瓣組明顯,兩者之間存在顯著異性(P 0.05);術(shù)后通過對(duì)兩組患者采用UW-QOL自評(píng)統(tǒng)計(jì)顯示,游離前臂皮瓣組與頦下島狀瓣組患者總體生存質(zhì)量無顯著差異(P0. 05);兩組患者滿意度比較游離前臂皮瓣組為58. 8% (10/17),低于頦下島狀瓣組的90. 6%%(29/32),兩組之間存在明顯差異(P0. 05)。[結(jié)論]1.通過研究對(duì)比顯示,游離前臂皮瓣與頦下島狀瓣均可較好的在口腔癌切除術(shù)后進(jìn)行即刻修復(fù)和功能重建,兩組患者術(shù)后生存質(zhì)量及受區(qū)的外形及功能恢復(fù)情況基本相近。2.從手術(shù)時(shí)間、術(shù)后滲出液量、皮瓣成活率、皮瓣及游離皮片感染壞死率以及滿意度來看,頦下島狀瓣組優(yōu)于游離前臂皮瓣組。應(yīng)用頦下島狀瓣可很好的降低術(shù)后供區(qū)的色素沉著、麻木或感覺異常及暫時(shí)性的功能障礙的發(fā)生,提升患者的滿意度,如果條件允許,頦下島狀瓣是很好的選擇,尤其是在不具備顯微外科技術(shù)的基層醫(yī)院。但對(duì)于有頸部淋巴結(jié)轉(zhuǎn)移的病人應(yīng)禁用該皮瓣。3.游離前臂皮瓣具有血管解剖變異小,血管蒂長,管徑粗大,皮瓣柔韌可折疊,抗感染能力強(qiáng)等優(yōu)勢(shì),對(duì)于口腔頜面部組織缺損較大或者頸淋巴結(jié)易發(fā)生早期轉(zhuǎn)移的患者可選用游離前臂皮瓣。
[Abstract]:[Objective] to compare the immediate repair and functional reconstruction of the free forearm flap and submental island flap in the repair of tissue defects after oral cancer surgery. The clinical value and characteristics of the two kinds of flaps were evaluated. [Methods] the inpatient department of oral and maxillofacial surgery in the Affiliated Stomatological Hospital of Kunming Medical University was collected from the free forearm flap and the chin in September -2016 June 2013. 49 cases of reconstruction of tissue defect after oral cancer were repaired with island flap. 49 cases of oral cancer were treated with radical resection and immediate repair of tissue defect after free forearm flap or submental island flap. 17 cases were repaired with free forearm flap, 32 cases were repaired by submental island flap, and SPSS21. 0 was used. The general data of the two groups, the time of operation, the total amount of exudate, the survival rate of the flap, the infection necrosis rate of the skin flap and the free skin, and the satisfaction of the patients were observed. The following up and observation of the patient's receiving area, the shape and function of the donor area were observed, and the patients were evaluated after the operation by the UW-QOL. [results] the preoperative data of SPSS21.0 analysis showed that the sex, average age, pathological grade and follow-up time of the two groups were basically similar, and there was no significant difference (P0. 05). The operation time of the free forearm flap group was (493.70 + 93.42) min, and the operative time of submental island flap group was (314.93 + 82.76) M In, the operation time of the free forearm flap group was significantly higher than the submental island flap group, and there was a significant difference between the two groups (P 0.01). The exudative fluid volume of the free forearm flap group was (314.70 + 125.88) ml, the postoperative exudation of the submental island flap was (247.31 + 102.08) ml, and the amount of exudative fluid in the free forearm flap group was significantly higher than that of the submental island. The difference between the two groups was statistically significant (P 0.05); the survival rate of the free forearm flap group was 88.23% (15/17), lower than 96.87% (31/32) (p0. 05) of the submental island flap, and the rate of infection and necrosis in the two groups was 29.41% (5/17), higher than that of the submental island flap (3.12% (1/32)). The difference between the two was statistically significant (P 0.05). The shape and function recovery of the two groups were almost similar, but the postoperative donor site statistics showed that the free forearm flap group was pigmented, numbness and temporary dysfunction was more obvious than that in the submental island flap group. In the two groups of patients, the total quality of life was no significant difference between the free forearm flap group and the submental island flap group (P0. 05), and the two groups of patients were compared with the free forearm flap group of 58.8% (10/17) and 90. 6%% (29/32) lower than the submental island flap group, and the two groups were obvious between the two groups. The difference (P0. 05). [conclusion]1. shows that free forearm flap and submental island flap can be used for immediate repair and functional reconstruction after oral cancer resection. The quality of life and the shape and function recovery of the two groups after operation are basically similar to that of.2. from operation time, postoperative exudative fluid volume, skin flap survival rate and skin. The submental island flap is superior to the free forearm flap in the infection necrosis rate and the satisfaction of the submental island flap. The submental island flap can greatly reduce the pigmentation, numbness or abnormal sensation and temporary dysfunction in the donor area after the operation. The submental island flap is good if the condition is allowed. Choice, especially in primary hospitals that do not have microsurgical techniques, but for patients with cervical lymph node metastases, the flap of the.3. free forearm flap should be disable with small vascular anatomy, long vascular pedicle, large diameter, flexible flap, strong anti infection and other advantages, such as larger oral and maxillofacial defects or neck drenching. Free forearm flap can be used in patients with early metastasis.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.8

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