CTA联合CDU辅助股前外侧皮瓣在舌癌术后缺损修复重建中的临床应用

Clinical application of CTA combined with CDU-assisted anterolateral thigh flap in repairing and reconstructing defects after tongue cancer operation

目的舌癌术后组织缺损严重影响患者生活质量,要求在提高患者生存率的同时改善生活质量。笔者采用CT血管造影(CTA)、彩色多普勒超声(CDU)及二者联合的方式辅助设计股前外侧穿支皮瓣进行舌重建,寻求最少损伤获取舌缺损的最优重建。方法选取蚌埠医学院第一附属医院口腔科从2017年7月-2020年9月40例舌癌拟行手术治疗舌体缺损的患者,采用随机数字表法将患者随机分为3组,A组20例患者术前应用CTA联合CDU评估旋股外动脉的穿支走行等情况,B组10例患者术前应用CTA及C组10例患者应用CDU进行评估,术中同期行皮瓣修复术同时对3组术中穿支点符合率、穿支类型符合率均采用Fisher精确检验进行分析,手术时间、术后住院天数采用方差分析,P<0.05为差异有统计学意义。结果 37例患者皮瓣均存活,A组1例皮瓣部分坏死,肌瓣存活;B组及C组各有1例患者出现静脉危象抢救后仍坏死。A组与C组在穿支类型符合率方面差异存在统计学意义(P=0.001)且A组在皮瓣制备时间方面显著优于B、C 2组(P=0.004),3组在穿支点符合率(P=0.244)及术后住院天数(P=0.845)方面差异无统计学意义。术后供、受区切口一期愈合;患者舌部形态及功能等恢复均达到满意效果,供受区均未见明显并发症。结论 CTA联合CDU对股前外侧皮瓣修复舌癌术后缺损具有较好的指导意义。

Objective The postoperative tissue defect of tongue cancer seriously affects the quality of life of patients,which requires improvement of their survival rate and quality of life.CT angiography(CTA),colour Doppler ultrasound(CDU)and their combination were used to assist in designing anterolateral thigh perforator flap for tongue reconstruction so as to seek the best reconstruction of tongue defect with the least damage.Methods From July 2017 to September 2020,40 patients with tongue cancer undergoing surgery for tongue defect were selected from the Department of Stomatol-ogy of the First Affiliated Hospital of Bengbu Medical College.The patients were randomly divided into three groups by random number table.Twenty patients in group A were evaluated by CTA combined with CDU before operation,10 patients in group B were evaluated by CTA before operation and 10 patients in group C were evaluated by CDU before operation.Skin flap repair was performed at the same time during the operation.Fisher accurate probability method was used to analyse the coincidence rate of perforating fulcrum and perforating branch type in the three groups.Variance anal-ysis was used to analyse the operation time and postoperative hospital stay,with P<0.05 as the statistical significance.Results All the flaps of 37 patients survived.One case in group A was partially necrotic,but the muscle flap survived.One patient in group B and group C still died of venous crisis after rescue.A significant difference was observed between groups A and C in the coincidence rate of perforating branch types(P=0.001).The time of skin flap preparation in group A was significantly better than those in groups B and C(P=0.004),but no significant difference was noted among the three groups in the coincidence rate of perforating branch points(P=0.244)and postoperative hospitalization days(P=0.845).Regarding primary healing of donor and recipient incision after operation,satisfactory results were a-chieved in tongue shape and function recovery,and no obvious complications were found in donor and recipient areas.Conclusion CTA combined with CDU has a good guiding significance in repairing postoperative defects of tongue cancer with anterolateral thigh flap.