采用组织瓣修复上颌骨缺损36例临床分析

Reconstruction of maxillary defects by vascularized tissue flap transfer:a clinicalanalysis of 36 cases

目的总结采用组织瓣进行上颌骨缺损重建的临床效果。方法回顾2012年8月2018年12月于我院行上颌骨切除并即刻行缺损重建的36例患者,分析上颌骨缺损类型与重建方法的关系。结果按照Brown分类,上颌骨Ⅱb类缺损22例,Ⅱc类缺损3例,Ⅱd类缺损8例,Ⅲb类缺损3例。33例(91.7%)Ⅱ类缺损中,采用腓骨瓣修复2例,颏下岛状瓣修复17例,前臂皮瓣修复14例。3例(8.3%)Ⅲb类缺损均采用组织瓣联合预成型的个性化钛网修复。所有患者皮瓣制备时间(64±15)min。手术时间(420.6±75.5)min,术中出血(650.5±172.3)mL,皮瓣最大12 cm×5 cm,最小8 cm×4 cm。术后所有组织瓣均完全成活,无一例发生局部坏死或完全坏死。术后平均随访(24.5±13.6)个月,随访期间,3例死亡(鳞癌T2N0M0和T3N0M0各1例,腺样囊性癌T3N0M01例),2例复发(均为腺样囊性癌T3N0M0),其余31例均无瘤生存;无一例发生口腔上颌窦瘘,外形满意率88.9%(32/36),发音清晰率为91.7%(33/36)。结论采用血管化组织瓣重建上颌骨Ⅱ类缺损能获得较为满意的外形、发音和口鼻腔封闭,组织瓣联合个性化钛网是修复上颌骨Ⅲ类缺损的适宜方法。

Objective To summarize the clinical outcomes of reconstruction of maxillary defects by vascularized tissue flap transfer.Methods Data of 36 patients underwent ablative surgery for maxillary tumor and immediate reconstructive surgery by vascularized tissue flaps in our hospital at August 2012 to December 2018 were retrospectively analyzed.The relationship between the types of the maxillectomy defect and reconstructive options was analyzed.Results According to Brown's Classification,there were 22 cases with classⅡb defect,3 cases classⅡc defect,8 cases classⅡd defect,and 3 cases classⅢb defect.There were 33 cases(91.7%)with classⅡdefect in the 36 patients,in which 2 cases were reconstructed by fibula flaps,17 cases submental island flaps,and 14 cases radial forearm flaps.Vascularized tissue flaps combined with a prefabricated personalized titanium mesh were used for reconstruction of the 3 cases(8.3%)with classⅢb defect.The average time of flap harvest was(64±15)min.The mean operation time was(420.6±75.5)min.The mean bleeding volume in operation was(650.5±172.3)mL.The tissue flaps were harvested with the sizes ranging from 4 cm×8 cm to 5 cm×12 cm.All transferred flaps survived completely,and no complete or partial necrosis occurred.The mean follow-up period was(24.5±13.6)months.Of the 36 patients,3 died including 2 with squamous cell carcinoma(T2N0M0/T3N0M0)and 1 with adenoid cystic carcinoma(T3N0M0),2 with adenoid cystic carcinoma(T3N0M0)relapsed,and the other 31 survived with tumor-free in the follow-up.None of the cases suffered from oroantral fistula.88.9%(32/36)of cases were satisfied with their aesthetic outcomes.Good speech outcomes were achieved in 91.7%(33/36)cases.Conclusion An excellent oronasal closure and satisfying aesthetic and speech outcomes could be achieved in cases reconstructed by vascularized tissue flaps for classⅡdefect.Tissue flap transfer combined with a prefabricated personalized titanium mesh provide an appropriated option for classⅢdefect.