吻合两条静脉的头颈部游离组织瓣移植

168 Cases of Free Flap Transplantation with Double Vein Anastomoses for Reconstruction of Head and Neck Defects

目的探讨吻合两条静脉的游离组织瓣移植在头颈部缺损修复中的可靠性和应用价值。方法选择1999年9月—2003年4月完成的168例同时吻合两条静脉的头颈部游离组织瓣移植的患者为研究对象。168例患者中男92例,女76例,年龄11～79岁,平均44.6岁。分析肿瘤的部位和类型、缺损的范围、所采用游离瓣的设计、受区静脉的选择、血管吻合技术和游离瓣的成活情况及术后并发症的发生情况。结果所采用的168块游离瓣中,腓骨瓣126块,前臂皮瓣32块,腹直肌皮瓣7块,肩胛瓣、空肠瓣和大腿前外侧皮瓣各1块。最常选用的受区静脉包括颈外静脉、面前静脉、面总静脉和颈内静脉,占全部受区静脉的86.0%。本组游离组织瓣的临床成活率为99.4%,术后1块腓骨瓣因动脉血栓而失败,但无1例游离瓣发生术中和术后静脉危象。结论同时吻合两条静脉的头颈部游离组织瓣移植可有效防止或降低游离瓣静脉危象的发生机率,提高了游离组织瓣移植的成功率。

Objective To evaluate the reliability and effectiveness of free flap transfer with double vein anastomosis for reconstruction of head and neck defects. Methods One hundred and sixty-eight cases of free flap transfers with double vein anastomosis for head and neck reconstruction from September 1999 to April 2003 were reviewed. There were 92 males and 76 females. The age range was 11 to 79 years old, with the average of 44.6 years old. Data concerning the operation included site, stage and histology of tumor, defect description, design of free flap, recipient vessel free flap survival and complications. Results Among 168 free flaps, there were 126 free fibula flaps, 32 radial forearm flaps, 7 rectus abdominis flaps, one scapular flap, one jejunal flap, and one anterolateral thigh flap. The overall success rate of free flap was 99.4%. One fibula flap was lost because of arterial thrombosis. No venous thrombosis occurred in this group. Conclusion Free flap transfer with double vein anantomosis for head and neck reconstruction improves the outflow of free flap, reduces the venous thrombosis rate, and ensures a high success rate of free flaps.