2019 年第 11 期 第 14 卷

血管化游离组织瓣修复口腔颌面部肿瘤术后缺损的临床观察

Clinical observation of vascularized tissue flap for reconstruction of oral and maxillofacial defects following tumor resection

作者：周涛钱永刘韦淞邓达赵方腾

英文作者：

单位：570312海口，海南省肿瘤医院头颈外科

英文单位：

关键词：口腔颌面部；缺损；肿瘤；血管化游离组织瓣

英文关键词：

• 摘要：

• 【摘要】目的    探讨血管化游离组织瓣对口腔颌面部肿瘤术后缺损的修复效果。方法    选取2012年4月至2016年2月于海南省肿瘤医院接受口腔颌面部肿瘤术后缺损修复治疗的450例患者作为研究对象，对患者病种、年龄、缺损部位、修复方式、组织瓣成活情况等临床资料进行回顾性分析，探讨血管化游离组织瓣的成功率及实际应用效果。结果    450例患者中，血管化游离组织瓣修复210例（46.7%），带蒂组织瓣修复172例（38.2%），随意皮瓣修复48例（10.7%），非血管化游离骨移植修复2例（0.4%），其他皮瓣修复18例（4.0%）。210例血管化游离组织瓣可分为前臂桡侧（尺侧）皮瓣89例、腓骨肌皮瓣60例、股前外侧皮瓣41例及背阔肌皮瓣20例，其中前臂桡侧（尺侧）皮瓣实际应用最多，失败率最低，患者适用年龄范围最广。按缺损部位分类，210例血管化游离组织瓣治疗患者口腔颌面部缺损包括舌缺损87例、口咽及颊缺损20例、口底缺损11例、上颌骨缺损31例、下颌骨缺损41例、偏面萎缩20例；210例游离组织瓣中2例游离腓骨肌皮瓣、2例游离股前外侧皮瓣及1例游离背阔肌皮瓣坏死，血管化游离组织瓣临床总成功率为97.6%（205/210）。结论    合理选择血管化游离组织瓣修复口腔颌面部肿瘤术后缺损，可有效改善患者的面部形态，促进其口腔功能的恢复，方案安全可靠，成功率较高，临床应用效果显著。

• 【Abstract】Objective    To observe the effect of vascularized tissue flap on repairing oral and maxillofacial defects following tumor resection. Methods    A total of 450 patients underwent oral and maxillofacial repair and reconstruction after tumor surgery using tissue flap in Hainan Cancer Hospital from April 2012 to February 2016. The type of disease, age, defect site, repair mode and tissue flap survival condition were retrospectively analyzed. The survival rate of vascularized tissue flap was observed. Results    Among the 450 patients, 210 patients used vascularized tissue flap(46.7%), 172 patients used pedicled tissue flap(38.2%), 48 patients used random flap(10.7%), 2 patients used non-vascularized bone graft(0.4%) and 18 patients used other flaps(4.0%). Vascularized tissue flaps included 4 types, which were radial or ulnar forearm flap in 89 cases, fibula osteomyocutaneous flap in 60 cases, anterolateral thigh flap in 41 cases, and latissimus dorsi flap in 20 cases. Radial or ulnar forearm flap represented the highest use rate, the lowest failure rate and the widest age range. Types of defects treated with vascularized tissue flap included tongue defect in 87 cases, oropharyngeal or buccal defect in 20 cases, oral floor defect in 11 cases, maxillary defect in 31 cases, mandible defect in 41 cases and partial atrophy in 20 cases. Necrosis occurred in 2 cases of fibula osteomyocutaneous flap, 2 cases of  anterolateral thigh flap and 1 case of latissimus dorsi flap. The survival rate of vascularized tissue flaps was 97.6%(205/210). Conclusions    Rational selection of vascularized tissue flap repairing oral and maxillofacial defect after tumor surgery can effectively improve facial morphology and promote oral function recovery. The success rate is remarkable and the clinical effect is satisfactory.