颏下岛状皮瓣修复口腔癌术后软组织缺损的疗效观察

Submental island pedicled flap for reconstruction of oral soft defects after oral cancer ablation

目的 探讨颏下岛状皮瓣修复口腔癌术后软组织缺损的疗效.方法 2010年2月至2013年3月,对30例口腔癌患者术后口腔软组织缺损应用颏下岛状皮瓣进行修复,对颏下岛状皮瓣的修复效果、优缺点、手术并发症、术后口腔功能恢复及肿瘤复发情况进行评价.采用SPSS软件进行统计分析.结果 制备的岛状皮瓣最小4 cm×6 cm,最大6cm×15cm;1例皮瓣术后发生浅层坏死,1例皮瓣完全坏死,修复成功率为96.7％（29/30）;手术时间4.5 ～7.5 h,平均6.8h;住院时间11～18 d,平均13 d;13例（43.3％）采用预防性气管切开术;手术后发生面神经下颌缘支暂时性麻痹1例,颈部血肿1例,颌下区积液7例,切口感染2例;手术后开口度：恢复正常23例,轻度开口受限6例,重度开口受限1例;语音功能恢复情况优良29例,差1例;吞咽功能：普食26例,可进软食3例,仅能进流质饮食1例;本组患者随访6～19个月,中位随访时间13个月,随访期内出现局部复发4例,颈部复发2例.结论 颏下岛状皮瓣具有安全、可靠、简便的优点,适合修复无颈部淋巴结转移的口腔癌术后的中小型软组织缺损.

Objective To evaluate the effectiveness of the submental island pedicled flap （SIPF） for the repair of oral soft defects following oral cancer ablation.Methods Thirty consecutive patients undergoing resection of oral cancer followed by reconstruction with SIPF from February 2010 to March 2013 were reviewed.The effectiveness complications,oral function recovering and oncologic outcomes after reconstructive operation with SIPF were evaluated.SPSS software was used to analyze the data.Results The dimensions of SIPF ranged from a minimum of 4 cm ×6 cm to a maximum of 6 cm × 15 cm.Of the 30 flaps,28 were survival completely,one had superficial necrosis but healed with treatments,and one failed due to complete necrosis,with a survival rate of 96.7% （29/30）.Operative time ranged from a minimum of 4.5 hours to a maximum of 7.5 hours,mean 6.8 hours,and hospital stay time was 11-18 days,mean 13 days.Thirteen patients （43.3%） received tracheotomy before SIPF operation.Surgical or postoperative complications included temporary marginal mandibular never palsy in one case,neck hematoma in one case,hydrops in the mandibular region in 7 cases,and neck infectionin in 2 cases.Postoperative functional results showed mouth opening was normal in 23 patients,light limitation of mouth opening in 6 cases and obvious limitation of mouth opening in one case.The speech function was re-obtained satisfactorily in 29 patients,but one case with poor speech function.Most patients showed normal swallowing function,of them 26 patients on a full oral diet,3 patients on a soft diet and one patient on a liquid diet only.Postopeative follow-up time was for 6-19 months （median 13 months）,and 4 patients had local recurrence and 2 patients had cervical lymph node metastases.Conclusion The SIPF is safe,reliable and simple for the reconstruction of middle-small oral soft defects following resection of early-stage oral cancer.