口腔癌根治术中同期游离股前外侧皮瓣修复效果的影响因素分析

Analysis on influencing factors of concurrent free anterolateral femoral skin flap repair in radical operation for oral cancer

目的探讨口腔癌根治术同期游离股前外侧皮瓣修复的疗效并分析皮瓣坏死的影响因素。方法选择我院2010年1月至2015年6月收治的98例口腔癌根治术同期游离股前外侧皮瓣修复患者的临床资料进行回顾性分析,统计皮瓣完全成活率、并发症发生率,将皮瓣成活与皮瓣坏死患者的年龄、糖尿病、受皮瓣区感染、吸烟、精神等情况进行对比,并行多因素Logistic回归分析。结果 98例患者中86例皮瓣完全成活(皮瓣成活组),成活率87.8%,15例皮瓣坏死(皮瓣坏死组),并发症发生率为15.3%(15/98),其中7例术区感染,5例大出血患者皮瓣坏死。所有患者供区切口均为一期愈合,患者对术后外形较为满意。皮瓣坏死组患者中年龄大于等于60岁、合并糖尿病、受皮瓣区发生感染、吸烟及精神差的发生率分别为41.7%、41.7%、58.3%、75.0%、83.3%,均高于皮瓣成活组患者中相应比例,差异有统计学意义(P<0.05)。多因素Logistic回归分析示年龄、糖尿病、受皮瓣区感染、吸烟、精神差均为皮瓣坏死组影响因素。结论口腔癌根治术同期游离股前外侧皮瓣修复疗效较好,年龄、合并糖尿病、吸烟、受皮瓣区感染、精神状态差等因素为口腔癌患者皮瓣修复中皮瓣坏死危险因素,临床治疗中应重视并干预。

Objective To explore the curative effect of oral cancer radical surgery plus free anterolateral thigh flap repair and analyze the influence factors of skin flap necrosis. Methods The data of 98 patients who underwent oral cancer radical surgery with concurrent free anterolateral thigh flap repair in our hospital from January 2010 to June 2015 were retrospectively analyzed. The complete survival rate of skin flaps and incidence of complications in all patients were statistically analyzed. The age,diabetes,infection in implanted skin flap area,smoking and mental status,etc. of patients with survived or necrotic skin flaps were compared between patients with survival flaps and patients with flap necrosis,and multivariate Logistic regression analysis was performed. Results Among the 98 cases,86 cases of flaps survived completely and the survival rate was 87. 8%. Fifteen cases with the skin flap necrosis,the incidence of complications was 15. 3%,including 7 cases of surgical site infection and 5 cases of skin flap necrosis with massive hemorrhage. The donor site incisions of all patients were primary healing and the patients were satisfied with the postoperative appearance. Among the patients with flap necrosis,the incidence rates of ≥60 years old,with diabetes,infection in flap implanted area,smoking and poor mental state（ 41. 7%,41. 7%,58. 3%,75. 0%,83. 3%） were higher than those corresponding proportions in the patients with with survival flaps（ P〈0. 05）. Multivariate Logistic regression analysis showed that age,diabetes,infection in implanted skin flap area,smoking and poor mental status were the influencing factors for flap necrosis. Conclusion Oral cancer radical surgery with concurrent free anterolateral thigh flap repair has good curative effects. The age,combined with diabetes,smoking,infection in flap implanted area and poor mental state are the risk factors for flap necrosis in patients with oral cancer after flap repair,which should be given intervention to improve the survival rate of skin flap in clinic.