儿童患者头颈部游离组织瓣移植的临床分析

Analysis of 30 Consecutive Free Flap Transplantation for Head and Neck Reconstruction in Paediatric Patients

目的 探讨儿童患者头颈部游离组织瓣移植的安全性、可靠性和应用价值。方法 对同一手术小组完成的 2 8例 15岁以下儿童患者的 30块头颈部游离组织瓣移植作回顾性研究。分析患者的一般情况、头颈部缺损的部位和类型、采用游离组织瓣的类型、受区血管、游离瓣成活情况及术后并发症的发生情况 ,并分析有可能影响游离瓣成活的各种因素。结果 2 8例患者一共采用了 4种游离瓣 ,即腓骨瓣 19块、前臂皮瓣 5块、肩胛皮瓣和腹直肌皮瓣各 3块。其游离瓣的临床成功率为 93 3% (2 8 30 ) ,1块腓骨瓣和 1块腹直肌皮瓣失败 ;受区和供区总的并发症发生率为 36 7% ,但并发症均不严重 ,没有造成严重的后果。结论 儿童患者头颈部游离组织瓣移植安全可靠 ,与成年患者相比其成功率和并发症无明显差别 ,值得进一步推广和应用。

Objective To analyze the reliability and feasibility of free flap transfer for head and neck reconstruction in the paediatric patients.Methods Thirty consecutive free flap transfer performed in 28 patients younger than 15 years-old were reviewed. Data concerning the operation included date of surgery, defect description and site, stage and histology of tumor, flap type, recipient vessel and complications.Results The average age of patients was 12.3 years-old, with age ranged from 5 to 15. There were 19 males and 9 females. Four kinds of free flap were used. The free fibula flap was most commonly used, followed by free radial forearm flap, rectus abdominis myocutaneous flap, and free scapular flap. The overall success rate of the flaps was 93.3%. The overall complication rate was 36.7%. The vessel thrombosis rate was 6.7%.Conclusion Free flap transfer in the paediatric patients for head and neck reconstruction is safe and reliable. There is no difference between the normal patients and paediatric patients in the success rate and complication rate.