面中区恶性肿瘤80例手术缺损的修复

Reconstruction of mid-face defects following the removal of malignant neoplasms： A review of 80 cases

目的 探讨对面中区恶性肿瘤术后缺损的修复手段及其疗效.方法 对北京同仁医院耳鼻咽喉头颈外科1997-2006年80例面中区恶性肿瘤术后缺损的患者的缺损程度、修复方法及疗效等因素进行回顾性分析.男54例,女26例;年龄23～79岁,中位年龄53.5岁.结合Brown分类方法,将80例鼻上颌骨区缺损分为4型,其中Ⅰ型：外鼻缺损6例;Ⅱ型：上颌骨缺损56例;Ⅲ型：鼻面上颌骨缺损14例;Ⅳ型：上颌骨合并鼻面眶部皮肤缺损4例.结果 80例患者修复方法分别为,带蒂肌皮瓣31例,游离皮瓣49例.Ⅰ期完成手术73例（91.2%）.经Kaplan-Meier生存分析,3年生存率为63.8%,5年生存率为40.6%.结论 面中区恶性肿瘤术后缺损的Ⅰ期修复可以获得满意疗效,应该根据缺损类型选择适当的修复手段.

Objective To evaluate the reconstructive methods of outcome of midface defects following the removal of malignant neoplasms. Methods Eighty cases （54 males, and 26 females, age ranging from 23-79, with a median age of 53.5 years） ,of midface malignant tumors from 1997-2006 in Beijing Tongren Hospital were retrospectively reviewed. The clinical data including the type of midface region defects,reconstructive methods and the therapeutic outcome were analyzed. Of the 80 patients,6 cases were with type Ⅰ （ external nasal ） defect,56 with type Ⅱ （maxillary） defect, 14 with type Ⅲ （naso-facio-maxillary）defect and 4 with type Ⅳ （ maxillary defect combined with naso-facio-orbital cutaneous deficiency）. Results The defects after the removal of malignant tumors were repaired with pedicle tissue flaps in 31 cases and free tissue flaps in 49 cases, respectively, one-stage reconstruction accounting for 73 cases （91.2%）. KaplanMeier analysis showed total 3-year and 5-year survival rates were 63.8% and 40. 6%, respectively.Conclusions One-stage reconstruction is a satisfactory method for the repair of midface defect after the removal of malignant tumor, with good clinical outcome. Selection of repair methods should be based on defect types.