股前外侧嵌合皮瓣与串联皮瓣修复口腔颌面部肿瘤根治术后缺损的疗效比较

COMPARISON OF REPAIR EFFECT BETWEEN CHIMERIC ANTEROLATERAL THIGH FLAP AND SERIES-WOUND FLAPS FOR DEFECT AFTER RESECTION OF ORAL AND MAXILLOFACIAL CANCER

目的比较股前外侧嵌合皮瓣及串联皮瓣修复口腔颌面部肿瘤根治术后缺损的疗效。方法回顾分析2011年1月-2014年7月39例采用股前外侧嵌合皮瓣修复口腔颌面部肿瘤根治术后缺损患者（嵌合皮瓣组）临床资料,以2009年1月-2010年12月采用串联游离皮瓣修复的35例患者（串联皮瓣组）作为对照。两组患者性别、年龄、病程、肿瘤类型、肿瘤分期及缺损范围、部位等一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。记录并比较两组手术时间、皮瓣制作及显微吻合时间、拔除胃管时间、开始经口进食时间,观察并发症发生情况;参照口腔颌面肿瘤根治术后骨与软组织缺损修复重建后临床疗效评估表（华盛顿大学生存质量量表）评价疗效。结果术后嵌合皮瓣组2例、串联皮瓣组4例皮瓣出现血管危象,串联皮瓣组1例皮瓣远心端出现部分坏死,串联皮瓣组3例出现口底颌下瘘和感染;其余患者皮瓣顺利成活,受区创面Ⅰ期愈合。供区植皮均顺利成活,切口Ⅰ期愈合。嵌合皮瓣组手术时间、拔除胃管时间、开始经口进食时间均显著少于串联皮瓣组,皮瓣制作及显微吻合时间长于对照组,比较差异均有统计学意义（P〈0.05）。两组患者均获随访,随访时间1-5年,平均2.5年。术后3个月,根据口腔颌面肿瘤根治术后骨与软组织缺损修复重建后临床疗效评估表,嵌合皮瓣组术后外形、患者满意度、工作状况、口腔闭合功能、咀嚼、语言表达、吞咽评分均显著高于串联皮瓣组（P〈0.05）;饮食、张口度、口腔容纳水测试及咬合评分比较,差异无统计学意义（P〉0.05）。结论与串联皮瓣相比,股前外侧嵌合皮瓣修复口腔颌面部肿瘤术后缺损能缩短手术时间、加快术后康复,同时有利于患者术后口腔闭合、咀嚼、语言、吞咽功能恢复。

Objective To compare the effectiveness of complex defects repair between using chimeric anterolateral thigh flap and series-wound flaps after resection of oral and maxillofacial cancer. Methods After resection of oral and maxillofacial cancer, defect was repaired with chimeric anterolateral thigh flap in 39 patients between January 2011 and July 2014（chimeric anterolateral thigh flap group）; and defect was repaired with series-wound flaps in 35 patients between January 2009 and December 2010（series-wound flaps group）. There was no significant difference in gender, age, duration of disease, tumor type, tumor staging, defect location, and defect area between 2 groups（P〈0.05）. The operation time, flap harvesting and microvascular anastomosis time, stomach tube extraction time, and oral feeding time were recorded and compared between 2 groups, and postoperative complications were observed; the effectiveness was evaluated according to clinical efficacy evaluation table of bone and soft tissue defects reconstruction surgery in oral and maxillofacial region. Results Vascular crisis occurred in 2 cases of chimeric anterolateral thigh flap group, and 4 cases of series-wound flaps group. Partial necrosis appeared at distal end of a series-wound flaps, and oral fistula and infection developed in 3 series-wound flaps. The other flaps and the grafted skin at donor site survived; wounds at recipient site healed by first intention. The operation time, stomach tube extraction time, and oral feeding time of chimeric anterolateral thigh flap group were significantly shorter than those of series-wound flaps group（P〈0.05）, while the flap harvesting and microvascular anastomosis time was significantly longer than that of series-wound flaps group（P〉0.05）. The patients were followed up 1-5 years（mean, 2.5 years）. At 3 months after operation, the appearance, patients＇ satisfaction, working conditions, oral closure function, chew, language performance, and swallowing scores of the chimeric anterolateral thigh flap group were significantly better than those of the series-wound flaps group（P〈0.05）, while there was no significant difference in diet, mouth opening degree, oral cavity holding water test, and occlusion scores between the 2 groups（P〉0.05）. Conclusion Using chimeric anterolateral thigh flap for defect repair after resection of oral and maxillofacial cancer can significantly shorten the operation time, accelerate postoperative rehabilitation, and help the functional recovery of oral closure, chewing, language performance, swallowing function when compared with the series-wound flaps.