三种游离组织瓣修复口腔、口咽肿瘤的回顾性研究

Comparison of three kinds of free flaps used in patients with oral and oropharyngeal tumors

目的对比口腔、口咽肿瘤患者应用3种常用游离软组织瓣进行修复重建手术后恢复情况及生活质量之间的差异。方法分析2014年7月至2020年8月期间,四川省肿瘤医院收治进行口腔、口咽肿瘤术后缺损一期修复的103例患者的临床资料,其中男66例,女37例,年龄26~74岁。应用游离股前外侧皮瓣(anterolateral thigh flap,ALTF)修复者43例,应用游离前臂桡侧皮瓣(radial forearm free flap,RFFF)者45例,应用游离上臂外侧皮瓣(lateral arm free flap,LAFF)者15例。总结3组患者皮瓣的相关数据,并应用华盛顿大学生活质量问卷和口腔健康影响程度量表(OHIP-14中文版)对患者术后生活质量进行评估。采用SPSS 23.0软件对数据进行分析。结果在T分期中,RFFF组和LAFF组的分期均低于ALTF组,差异有统计学意义(P值均<0.05)。在皮瓣特征方面,ALTF组皮瓣面积[(55.87±27.38)cm^(2)]与LAFF组[(49.93±19.44)cm^(2)]差异无统计学意义(t=0.772,P=0.443),RFFF组[(33.18±6.05)cm^(2)]皮瓣面积小于ALTF组(t=5.311,P<0.001)与LAFF组(t=3.284,P=0.005)。关于术后1年华盛顿大学生活质量问卷评价,在口腔功能方面(包括吞咽、咀嚼、味觉、唾沫),LAFF组和RFFF组得分差异无统计学意义(P值均>0.05),2组皆高于ALTF组(P值均<0.05);在外观上,LAFF组[75(75,75)分]与ALTF组[75(75,75)分]得分差异无统计学意义(Z=-1.532,P=0.126),2组皆高于RFFF组[50(50,75)分,Z值分别为-3.447和-3.005,P值均<0.05];讲话方面,RFFF组为100(67,100)分,高于LAFF组[67(50,76)分]和ALTF组[67(33,67)分],差异有统计学意义(Z值分别为-2.480和-5.414,P值均<0.05)。在华盛顿大学生活质量问卷评价量表平均得分中,ALTF组得分[72(56,77)分]低于RFFF组[79(69,89)分],差异具有统计学意义(Z=-3.070,P<0.05),ALTF组与LAFF组得分差异无统计学意义(Z=1.754,P=0.079)。术后1年口腔健康影响程度量表(OHIP-14中文版)评价,ALTF组各项目及平均得分均低于RFFF组和LAFF组(P值均<0.05)。RFFF组和LAFF组得分差异无统计学意义(P值均>0.05)。结论对于口腔、口咽肿瘤患者应用不同皮瓣进行的修复重建,在缺损大小的修复上,RFFF对于较小组织缺损有独特优势,ALTF适合于较大组织缺损,LAFF是介于ALTF与RFFF之间的一个折中的选择。在口腔功能重建方面,ALTF逊色于RFFF和LAFF;在术后外观方面,ALTF和LAFF优于RFFF。

Objective To compare the recovery and quality of life of patients with oral and oropharyngeal tumors treated with three kinds of free soft tissue flaps.Methods The clinical data of 103 patients,including 66 males and 37 females,aged 26-74 years,who underwent primary repair of defects after resection of oral and oropharyngeal tumors in Sichuan Tumor Hospital from July 2014 to August 2020 were analyzed.Anterolateral thigh flap(ALTF)was used in 43 patients,radial forearm free flap(RFFF)in 45 patients,and lateral arm free flap(LAFF)in 15 patients.Postoperative qualities of life of patients were evaluated by the university of Washington quality of life questionnaire and oral health impact scale(HIP-14 Chinese edition).SPSS 23.0 software was used for statistical analysis.Results The T staging of RFFF or LAFF group was significantly lower than that of ALTF group(P<0.05).There was no significant difference in mean flap areas between ALTF group((55.87±27.38)cm^(2))and LAFF group((49.93±19.44)cm^(2)),while RFFF group had smaller mean flap area((33.18±6.05)cm^(2))than ALTF group(t=5.311,P<0.001)and LAFF group(t=3.284,P=0.005).In terms of oral functions including swallowing,mastication,taste and spitmouth,there were no significant differences between LAFF group and RFFF group(P>0.05),but both groups had better oral functions than ALTF group(P<0.05).There was no significant difference in appearance scores between LAFF group(75(75,75))and ALTF group(75(75,75)vs.75(75,75),Z=-1.532,P=0.126),and both groups had higher scores than RFFF group(50(50,75),Z values were-3.447 and-3.005 respectively,P<0.05).RFFF group had higher speech score(100(67,100))than LAFF group(67(50,76),Z=-2.480,P<0.05)and ALTF group(67(33,67),Z=-5.414,P<0.05).ALTF group had lower mean score of quality of life than RFFF group[72(56,77)vs.79(69,89),Z=-3.070,P<0.05),but there was no statistical difference in the mean scores of qualities of life between ALTF group and LAFF group(Z=1.754,P=0.079).According to the evaluation of oral health impact scale(HIP-14 Chinese version)1 year after surgery,individual item scores and the average score of all items in ALTF group were lower than those in RFFF and LAFF groups(P<0.05),with no significant difference between RFFF group and LAFF group(P>0.05).Conclusions RFFF has unique advantages for small tissue defects,while ALTF is suitable for large tissue defects,such as buccal penetrating defect,whole tongue and near whole tongue defect,and LAFF is a compromise choice between ALTF and RFFF.ALTF is inferior to RFFF and LAFF in oral functional reconstruction,including swallowing,chewing,taste and spittle.ALTF and LAFF are superior to RFFF in postoperative appearance.