全舌及近全舌缺损的显微外科修复

Microsurgical reconstruction for total and subtotal glossectomy defects

目的探讨全舌及近全舌缺损的修复方法，评价游离组织瓣修复全舌及近全舌缺损的应用价值。方法收集1999年3月至2012年6月北京大学口腔医学院口腔颌面外科四病区45例肿瘤切除术后全舌或近全舌缺损修复患者的临床资料，记录并分析原发灶情况、T分级、N分级、修复方法及术后并发症。结果全舌或近全舌缺损患者45例，其中男23例，女22例，年龄23～77岁，中位年龄56岁。原发灶的病理诊断分别为鳞状细胞癌41例、腺源性癌2例、肉瘤1例及透明细胞癌1例。修复方法为股前外侧皮瓣19例、前臂皮瓣18例、腹直肌皮瓣2例、腹壁下动脉穿支皮瓣2例、腓肠内侧动脉穿支皮瓣1例和腓骨瓣皮岛3例，游离皮瓣移植成功率为95．6％（43／45）。所有患者均行气管切开术，住院期间均拔除气管套管，平均拔管时间为术后8．1d。40．0％（18／45）患者出院时因吞咽功能障碍而保留鼻饲管。结论游离组织瓣移植修复全舌及近全舌缺损安全可靠，术后功能有一定的恢复。

Objective To investigate the methods for reconstruction of total and subtotal glossectomy defects and evaluate the application of free flaps for reconstruction of total and subtotal glossectomy defects. Methods A retrospective study was performed with the patients of total or subtotal glossectomy at the Department of Oral and Maxillofacial surgery, Peking University School of Stomatology from March, 1999 to June, 2012. Clinical data of the primary tumor, T stage, N stage, method of reconstruction and post-operative complications were recorded. Results The data of 45 cases with reconstruction of total or subtotal glossectomy defects were collected. There were 23 females and 22 males with the median age of 56 years old. The primary tumor presented to be squamous cell carcinoma in 41 cases, adenocarcinoma in 2 cases, sarcoma in 1 case, and clear cell carcinoma in 1 case pathologically. There were 19 cases with anterolateral thigh flap, 18 cases with radial forearm flap, 2 cases with rectus abdominis musculocutaneous flap, 2 cases with deep inferior epigastric artery perforator flap, 1 case with medial sural artery perforator flap and 3 cases with the skin paddle of fibular flap. The overall successful rate of free flap transfer was 95.6% （43/45）. All patients were underwent tracheotomy, and the average time of extubation was 8.1 days after surgery. The nasogastric tubes were retained in 40% （18/45） of the patients at the time of discharge for the difficulty swallowing. Conclusion Free flap transfer is reliable and safe for reconstruction of total or subtotal glossectomy defects. The acceptable postoperative oral function recovery can be achieved.