组织瓣移植修复舌癌术后组织缺损的围手术期护理

Nursing care of patients with tongue cancer surgically treated and reconstructed with tissue flaps

目的舌癌手术切除后遗留缺损常采用各种组织瓣移植修复,以恢复其外形和功能。文中探讨前臂皮瓣、腹直肌皮瓣、股前外侧皮瓣及胸大肌皮瓣移植修复舌癌术后组织缺损的围手术期护理措施。方法对47例应用前臂皮瓣、腹直肌皮瓣、股前外侧皮瓣、胸大肌皮瓣移植修复舌癌术后遗留缺损患者进行相关护理,以预防并发症的发生。结果随访患者2个月～8年,47例移植皮瓣中42例全部成活、1例全部坏死、4例皮岛尖端小部分皮肤坏死(均不超过皮岛面积的10%)。7例全舌缺损修复患者言语欠清,咀嚼和吞咽功能差,只能进流质饮食;40例半舌或部分舌缺损修复患者舌外形恢复良好,言语、咀嚼和吞咽功能恢复良好。结论细致、周到的护理对皮瓣移植修复舌癌术后缺损具有重要临床意义。

Objective Reconstruction procedure with flap transfer after tongue cancer resection is critical to restore function and esthectic outcomes.This study was to investigate the preoperative and postoperative nursing measure of the forarm flap,rectus abdominis myocutaneous flap,anterolateral thigh flap or pectoralis major myocutaneous flap in repairing the tongue defects.Methods Forty-seven consecutive patients with tongue cancer surgically treated and reconstructed with tissue flaps were nursed.The effect was studied and complications encountered were documented.Results Forty-seven cases were followed for 2 months-8 years.There were 42 flaps alive,with 4 flaps in which 10% or less of the skin paddle sloughed and 1 total flaps loss were defective in 7 patients with total tongue reconstruction were found that their speech intelligibility and swallowing function,with only eating liquid diet.The contour and function of tongue were restored well in 40 patients with part or half of tongue reconstruction.Conclusion Careful nursing care is of vital importance in reconstruction of tongue defects with tissue transfer.