头颈部恶性肿瘤术后缺损修复皮瓣围手术期综合护理

Clinical effects of comprehensive nursing in repairing the defect skin flap in patients with head and neck malignant tumor at peroperative period

目的探讨头颈部恶性肿瘤术后缺损修复皮瓣围手术期综合护理效果。方法回顾分析2016年1月至2018年6月收治的53例头颈部恶性肿瘤术后缺损皮瓣修复患者资料,其中男32例,女21例;年龄36~80岁,平均62.5岁。其中颊癌20例,软腭癌12例,牙龈癌9例,下咽癌7例,喉癌5例。采用带蒂皮瓣修复40例,含颏下岛状皮瓣23例,胸大肌皮瓣12例,内乳穿支皮瓣5例。游离皮瓣13例,含前臂皮瓣10例,股前外侧皮瓣3例。所有患者行围手术期综合护理。结果术后51例皮瓣存活,存活率96.22%,2例皮瓣坏死,坏死率3.77%。4例血管危象,发生率7.54%,含3例静脉危象,1例动脉危象,1例皮瓣感染,1例皮瓣下血肿。结论完善的围手术期综合护理对头颈部恶性肿瘤术后缺损皮瓣修复患者至关重要,可获得良好的临床护理效果。

Objective To investigate the clinical effects of comprehensive nursing in repairing the defect skin flap in patients with head and neck malignant tumor after operation.Methods The clinical data about 53 patients with head and neck malignant tumor who underwent the defect skin flap repairing after operation were retrospectively analyzed,of whom,there are 32 males and 21 females,with age range being 36~80yr(average 62.5 years of age).Of them,there were 20 cases of buccal cancer,12 cases of soft palate cancer,9 cases of gum cancer,7 cases of hypopharyngeal cancer and 5 cases of laryngeal cancer.A total 40 patients were treated by pedicle flap,including 23 cases of submental island flap,12 cases of thoracic large muscle flap,and 5 cases of internal lacteal perforator flap.Moreover 13 patients were treated by free flap,including 10 cases of forearm flap and 3 cases of anterolateral femoral flap.All the patients received perioperative comprehensive nursing.Results The skin flap survived in 51 cases,with survival rate being 96.22%.The skin flap necrosis was found in 2 cases,the incidence rate of necrosis was 3.77%.There were 4 cases of vascular crisis,with the incidence rate being 7.54%,including 3 cases of venous crisis and 1 case of arterial crisis.Moreover there was 1 case of flap infection and 1 case of subflap hematoma.Conclusion The perfect perioperative comprehensive nursing is very important for repairing the defect skin flap in patients with head and neck malignant tumor after operation,which can obtain better clinical nursing effects.