自体游离组织瓣在头颈肿瘤术后缺损重建的临床研究

Clinical Study of Free Flap in Head and Neck Defects Reconstruction

目的探讨自体游离组织瓣修复头颈部术后组织缺损的临床应用价值。方法收集2008年5月至2012年10月期间头颈科肿瘤手术治疗的病例共71例进行分组分析,其中修复组应用自体游离组织瓣修复重建头颈部组织缺损(33例),对照组未应用游离组织瓣修复(38例),总结游离组织瓣应用的经验及价值。结果 33例自体游离组织瓣中前臂皮瓣修复重建17例(舌缺损12例、口颊粘膜5例),腓骨骨皮瓣修复颌骨缺损9例,股前外侧皮瓣3例(口底2例、面部皮肤1例),空肠瓣修复颈段食管2例,足背皮瓣修复口颊粘膜1例,髂骨瓣修复下颌骨1例。其中2例部分坏死,其余31例均获成功。舌切除后应用前臂皮瓣修复的修复组发音清晰度和吞咽功能比对照组好。上下颌骨缺损的修复组面部颌骨外形好于对照组。结论不同自体组织瓣血管化应用头颈肿瘤手术后原发病灶缺损I期重建修复,不仅有助于肿瘤切除彻底,而且术后功能恢复较好。

Objective To study the clinical value of autologous free tissue flap in the reconstruction of head and neck tissue defects. Methods 71 patients who received surgery between May 2008 and October 2012 were analyzed. 33 patients who received reconstruction of head and neck tissue defects by autologous free flap were in the testing group. 38 subjects in the control group did not use free tissue flap to repair the defects. Results Among the 33 cases of autologous free flaps, there were 17 cases of the radial forearm flap reconstruction （12 cases of tongue defects, 5 cases of mouth buccal）, 9 cases of the fibula flap repairing of maxillary or mandible defects, 3 cases of the anterolateral thigh flap （2 cases in the floor of the mouth, 1 case facial skin）, 2 cases of free jejunal flap repairing of cervical esophagus, 1 case of dorsalis pedis flap repairing of huccal mouth, and 1 case of free iliac flap repairing of mandible.2 out of 33 cases were found to have necrosis. The speech articulation and swallow function of forearm flap repairing group were better than the non-repairing group after tongue excision. The facial shapes of the testing group were better than the control group after the repairing of the mandible defect. Conclusion Autologous tissue flap used in stage-I repairing and reconstruction after head and neck tumors operation can not only help to remove the tumor, but also help the postoperative functional recovery and preservation.