游离股前外侧皮瓣在颌面部组织缺损移植重建中的应用

朱伟政; 陈传俊

doi:10.16766/j.cnki.issn.1674-4152.002312

游离股前外侧皮瓣在颌面部组织缺损移植重建中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002312

朱伟政^,,
陈传俊

中国科学技术大学附属第一医院(安徽省立医院)口腔颌面外科, 安徽合肥 230001

基金项目:

安徽高校协同创新项目 GXXT-2020-021

详细信息

通讯作者:
朱伟政, E-mail: juta2002@sina.com

中图分类号: R739.81 R782.2
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- 被引次数: 0
出版历程
- 收稿日期: 2021-05-08
- 网络出版日期: 2022-03-04

Free anterolateral thigh flap in maxillofacial tissue defect application in transplantation and reconstruction

ZHU Wei-zheng^,,
CHEN Chuan-jun

Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei, Anhui 230001, China

摘要

摘要: 目的探讨游离股前外侧皮瓣(free anterolateral thigh myocutaneous flap)在口腔颌面部各类恶性肿瘤(以口腔鳞状细胞癌为主)患者的治疗过程中，应用于恶性肿瘤根治术后头颈颌面部大面积组织缺损移植重建的治疗效果。方法选取2015年4月—2020年8月在安徽省立医院口腔颌面外科住院行手术治疗的66例游离股前外侧皮瓣移植重建口腔癌根治术后颌面部缺损患者，对患者的一般资料，修复部位，术后口腔言语、咀嚼、吞咽功能恢复状况，术后外形的满意程度，以及相关术后随访数据等进行回顾性分析，通过问卷调查的方式以及SPSS 23.0统计学软件进行分析，详细研究游离股前外侧皮瓣在临床设计制备、吻合重建、术后并发症以及患者外观及功能等各方面存在的优势及不足。结果 66例患者皮瓣一期成活64例，其中因血管栓塞导致术后皮瓣坏死2例，成功率为96.97%。所有患者术后皮瓣供区无严重并发症出现。除去原发灶过于巨大的T4期患者因口腔颌面部组织缺损过多，严重影响术后正常生理功能外，剩余85%以上的患者术后3个月即可获得较为满意的言语及进食功能恢复，93.94%的患者对术后外观形态满意或可接受。各类口腔癌患者术前术后张口度、进食及言语功能等方面对比差异有统计学意义(均P < 0.05)。结论游离股前外侧皮瓣因其制取简单、设计灵活、功能强大、供区隐蔽等诸多优点极其适合作为口腔颌面外科头颈部组织缺损重建的首选“个性化”修复皮瓣。
- 游离股前外侧皮瓣 /
- 颌面部组织缺损 /
- 穿支皮瓣
Abstract: Objective To explore the clinical treatment of oral and maxillofacial malignant tumours (primarily oral squamous cell carcinoma) with free anterolateral thigh flap. The therapeutic effects of transplantation and reconstruction of large tissue defects in head, neck, and maxillofacial area after radical resection of malignant tumour were examined. Methods From April 2015 to August 2020, 66 cases of maxillofacial defects after radical oral cancer were reconstructed by free anterolateral femoral flap transplantation in the Oral and Maxillofacial Surgery Department of Anhui Provincial Hospital. Data including general information, repair site, recovery of oral speech, chewing and swallowing functions after surgery, and satisfaction degree of postoperative appearance were collected. Related postoperative follow-up data were retrospectively analysed through questionnaire and SPSS 23.0 statistical software analysis. A detailed study of the advantages and disadvantages of free femoral anterolateral flap in clinical design preparation, data reconstruction, postoperative complications, and patient's appearance and function was conducted. Results A total of 64 of the 66 patients survived the first stage of the flap, including two patients with postoperative skin flap necrosis due to vascular embolisation, with a success rate of 96.97%. No serious complications occurred in the donor area of postoperative flap. In addition to the T4 patients with excessively large primary lesions, whose oral and maxillofacial tissue defects seriously affected the normal physiological function after surgery, the remaining 85% of patients could recover their speech and eating function satisfactorily 3 months after surgery. More than 93.94% of patients were satisfied or acceptable with the postoperative appearance. Statistically significant differences in mouth opening, food intake, and speech function existed amongst all kinds of oral cancer patients before and after surgery (all P < 0.05). Conclusion The free anterolateral femoral flap is the first choice for the reconstruction of head and neck tissue defects in oral and maxillofacial surgery due to its advantages such as simple preparation, flexible design, powerful function, and concealed donor area.
- Free lateral thigh flap /
- Maxillofacial tissue defect /
- Perforator flap

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表 1 游离股前外侧(肌)皮瓣移植术后成活率统计分析

项目	类别	总例数	成功(例)	坏死(例)	成活率(%)
性别	男性	46	45	1	97.83
	女性	20	19	1	95.00
病灶部位	舌癌	29	27	2	93.10
	颊癌	20	20	0	100.00
	牙龈癌	3	3	0	100.00
	口底癌	7	7	0	100.00
	腭癌	3	3	0	100.00
	口咽癌	4	4	0	100.00

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表 2 66例游离股前外侧皮瓣修复口腔癌术后缺损患者术后3个月外形及功能随访情况[例(%)]

病灶部位	例数	术后形态			封闭功能		言语功能		咀嚼功能		吞咽功能
病灶部位	例数	满意	可接受	不满意	封闭良好	偶尔溢涎	正常交流	勉强交流	正常	半流质	正常	半流质
舌癌	29	15(51.72)	10(34.48)	4(13.79)	29(100.00)	0	25(86.2)	4(13.79)	28(96.55)	1(3.45)	29(100.00)	0
颊癌	20	18(90.00)	2(10.00)	0	19(95.00)	1(5.00)	20(100.00)	0	20(100.00)	0	20(100.00)	0
牙龈癌	3	0	3(100.00)	0	3(100.00)	0	3(100.00)	0	0	3(100.00)	3(100.00)	0
口底癌	7	5(71.43)	2(28.57)	0	7(100.00)	0	4(57.14)	3(42.85)	5(71.43)	2(28.57)	7(100.00)	0
腭癌	3	3(100.00)	0	0	3(100.00)	0	3(100.00)	0	2(66.67)	1(33.33)	3(100.00)	0
口咽癌	4	4(100.00)	0	0	4(100.00)	0	3(75.00)	1(25.00)	4(100.00)	0	1(25.00)	3(75.00)
合计	66	45(68.18)	17(25.76)	4(6.06)	65(98.48)	1(1.52)	58(87.88)	8(12.12)	59(89.39)	7(10.61)	63(95.45)	3(4.55)
注：本表中封闭功能、言语功能、咀嚼功能及吞咽功能4项中，因术后患者虽有不同程度的生理功能影响，但其中并无绝对完全无法言语、无法封闭及无法咀嚼吞咽的患者，故随访统计结果中此4项中无1级分级患者，且并未在表中列出。

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