便携式可视拉钩在颞浅筋膜瓣切取术中的临床应用效果

Clinical application effects of portable visual retractor in superficial temporal fascia flap harvesting

目的探讨便携式可视拉钩在颞浅筋膜瓣切取术中的临床应用效果。方法2010年1月—2019年6月,解放军总医院第一临床医学中心整形修复科收治27例符合入选标准的拟行颞浅筋膜瓣切取的患者,按照颞浅筋膜瓣切取方式分为传统手术方式组[男6例、女3例,年龄(34±14)岁]、冷光源拉钩组[男6例、女4例,年龄(35±16)岁]以及可视拉钩组[男7例、女1例,年龄(30±14)岁]。传统手术方式组患者采用传统切开方式行颞浅筋膜瓣切取,冷光源拉钩组和可视拉钩组患者分别于冷光源拉钩和便携式可视拉钩辅助下行颞浅筋膜瓣切取。统计3组患者颞浅筋膜瓣切口长度、手术时间、术中出血量、术后引流量、术后并发症。对数据行Fisher确切概率法检验、单因素方差分析、LSD检验、Kruskal-Wallis H检验及Bonferroni校正。结果可视拉钩组患者切口长度为(3.6±0.8)cm,明显短于传统手术方式组的(12.6±1.6)cm和冷光源拉钩组的(5.8±0.9)cm,P<0.05。传统手术方式组患者切口长度明显长于冷光源拉钩组(P<0.05)。可视拉钩组患者手术时间为24.0(23.3,25.8)min,明显短于传统手术方式组的35.0(30.5,36.5)min和冷光源拉钩组的28.5(26.8,30.5)min,H=16.5、9.8,P<0.05。传统手术方式组患者手术时间明显长于冷光源拉钩组(H=6.6,P<0.05)。可视拉钩组患者术中出血量为(26±3)mL,明显少于传统手术方式组的(34±4)mL和冷光源拉钩组的(30±6)mL,P<0.05。传统手术方式组患者术中出血量明显多于冷光源拉钩组(P<0.05)。传统手术方式组、冷光源拉钩组和可视拉钩组患者术后引流量分别为(33±4)、(34±6)、(31±7)mL,组间总体比较,差异无统计学意义(F=0.3,P>0.05)。3组患者术后均未出现颞浅筋膜瓣缺血坏死等严重并发症,冷光源拉钩组1例患者术后出现皮下血肿,经拆线清除血肿后好转。结论便携式可视拉钩辅助下切取颞浅筋膜瓣具有视野清晰、操作简单、手术时间短、手术切口小、术中出血少等优点。

Objective To explore the clinical application effects of portable visual retractor in superficial temporal fascia flap harvesting.Methods From January 2010 to June 2019,27 patients meeting the inclusion criteria and planning to perform operation of superficial temporal fascia flap harvesting were admitted to the Department of Plastic and Reconstructive Surgery of the First Clinical Medical Center of the People′s Liberation Army General Hospital.The patients were divided into traditional surgical method group[6 males and 3 females,aged(34±14)years],cold light source retractor group[6 males and 4 females,aged(35±16)years],and portable visual retractor group[7 males and 1 female,aged(30±14)years]according to way of superficial temporal fascia flap harvesting.The superficial temporal fascia flaps of patients in traditional surgical method group were resected by traditional way of resection,and the superficial temporal fascia flaps of patients in cold light source retractor group and portable visual retractor group were resected at assistance of cold light source retractor and portable visual retractor,respectively.Length of incision,operation time,intraoperative blood loss volume,postoperative drainage volume,and postoperative complication of patients in 3 groups were observed and recorded.Data were processed with Fisher′s exact probability test,one-way analysis of variance,least significant difference test,Kruskal-Wallis H test,and Bonferroni correction.Results The length of incision of patients in visual retractor group was(3.6±0.8)cm,significantly shorter than(12.6±1.6)cm in traditional surgical method group and(5.8±0.9)cm in cold light source retractor group(P<0.05).The incision length of patients in traditional surgical method group was significantly longer than that in cold light source retractor group(P<0.05).The operation time of patients in visual retractor group was 24.0(23.3,25.8)min,significantly shorter than 35.0(30.5,36.5)min in traditional surgical method group and 28.5(26.8,30.5)min in cold light source retractor group(H=16.5,9.8,P<0.05).The operation time of patients in traditional surgical method group was significantly longer than that in cold light source retractor group(H=6.6,P<0.05).The intraoperative blood loss volume was(26±3)mL of patients in visual retractor group,significantly less than(34±4)mL in traditional surgical method group and(30±6)mL in cold light source retractor group(P<0.05).The intraoperative blood loss volume of patients in traditional surgical method group was significantly more than that in cold light source retractor group(P<0.05).The postoperative drainage volumes of patients in visual retractor group,cold light source retractor group,and traditional surgical method group were(33±4),(34±6),and(31±7)mL,respectively,and there were no significantly statistical differences in postoperative drainage volumes among patients in the three groups(F=0.3,P>0.05).There were no severe complications such as ischemia and necrosis of superficial temporal fascia flaps in patients of the three groups.One patient in cold light source retractor group had subcutaneous hematoma after operation,which was improved by removing stitches and hematoma.Conclusions Superficial temporal fascia flap harvesting at the assistance of portable visual retractor has the advantages of clear visual field,simple operation,short operation time,small incision,and less intraoperative blood loss.