两种不同方法修复唇颊部术后缺损17例临床分析

Clinical Analysis of Two Repair Methods for 17 Cases of Complex Defection after Lip and Buccal Cancer Surgery

目的:进一步探讨采用前臂皮瓣或颏下岛状瓣修复唇颊癌术后唇颊部联合缺损的临床效果。方法:回顾性分析17例唇颊癌患者,其中鳞状细胞癌13例,基底细胞癌4例;其中T_2N_0M_0 9例,T_3N_0M_0 5例,T_2N_1M_0 3例,采用前臂皮瓣修复10例,颏下岛状瓣修复7例,术后随访6个月至8年。结果:17例患者术后创口均一期愈合;15例患者局部无复发,1例患者术后4个月局部复发,1例患者术后6个月颌下淋巴结转移复发,2例复发均为鳞状细胞癌,其中1例为术后有淋巴结转移患者。两种不同修复方法治疗后唇颊外形,咀嚼功能,吞咽功能,语言功能均无明显差别。结论:采用前臂皮瓣或颏下岛状瓣修复唇颊癌术后唇颊部缺损,从术后外形与功能上比较无明显区别,对怀疑有颌下或颏下淋巴结转移的患者采用颏下岛状瓣修复需慎重考虑。

Objective Discuss the clinical effect of reconstruction for combined defection using free forearm fap and submental artery island fap following lip and lingual cancer surgery. Methods Retrospective analyze 17 cases of lip and buccal cancer, including 13 cases of squamous cell carcinoma, 4 cases of basal cell carcinoma; 9 cases of T2N0M0, 5 cases of T3N0M0, 3 cases of T2N1M0; 10 cases were repaired by free forearm fap, 7 cases were repaired by submental artery island fap. The following up period were 6 months to 8 years. Results 17 cases gained primary wound healing. 15 cases had no local recurrence in following up period, one case was found local recurrence 4 months after post-operation, one case was found sub mandible lymph node metastasis after 6 months, and both were pathologically confrmed as squamous cell carcinoma, in which one case was originally lymph node metastasis confrmed by post-operation pathology. There was no signifcant cosmetic or functional difference between two repair methods. Conclusion There was no significant cosmetic or functional difference between free forearm flap and submental artery island fap as reconstructive methods for combined defection after buccal and lip carcinoma. Serious consideration is necessary before using submental artery island fap in cases of submental or sub mandible lymph node metastasis.