游离小腿后外侧腓动脉穿支皮瓣在全舌、次全舌切除术后修复中的临床应用

Clinical application of peroneal artery perforator flap in repairing defects after total glossotomy and subtotal glossotomy

目的评价游离小腿后外侧腓动脉穿支皮瓣重建全舌、次全舌切除术后缺损的临床效果。方法回顾性分析2017年1月至2019年1月蚌埠医学院第一附属医院口腔颌面外科收治的舌癌患者临床资料,患者均行全舌、次全舌切除,并采用游离小腿后外侧腓动脉穿支皮瓣行一期修复。术后1、2、3年随访观察患者生存状态。术后3、6、12个月采用洼田饮水试验、语音清晰度测试表和筛分称重法分别对吞咽、语音清晰度及咀嚼功能进行评价,统计数据并采用t检验分析计量资料,P<0.05为差异有统计学意义。结果共选择20例舌癌患者临床资料,男16例,女4例,年龄46~68岁,平均54.1岁。切取腓动脉穿支皮瓣大小为6.0 cm×7.0 cm~6.5 cm×8.0 cm,血管蒂的长度为6.0~7.0 cm,皮瓣总体成活率95.0%(19/20)。术后1、2、3年的生存率分别为95.0%、73.7%、64.3%,无瘤生存率分别为95.0%、63.2%、57.1%。随着术后时间的延长,吞咽、语音清晰度及咀嚼等功能逐渐改善,术后6个月与3个月比较差异有统计学意义(P<0.05);在语音方面术后12、6个月比较,差异有统计学意义(P<0.05)。结论腓动脉穿支血管解剖恒定,穿支血管的直径和长度均较适合于游离穿支皮瓣的制备,其营养的小腿后外侧组织量丰富,利于修复全舌、次全舌缺损,患者术后在吞咽、语音清晰度及咀嚼等功能方面恢复较为理想。

Objective To evaluate the clinical effect of free peroneal artery perforator flap(FPAPF)for reconstructing defects of total glossotomy and subtotal glossotomy.Method A retrospective analysis of the clinical data of the patients with tongue cancer was performed.The patients were admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2017 to January 2019.All the patients underwent total tongue and subtotal tongue resection and one-stage repair with FPAPF.The function of swallowing,speech and chewing were evaluated with the water swallow test,the speech intelligibility test and the screening and weighing method at 3 months,6 months,and 12 months after the operation.Use t-test to analyze the data and P<0.05 was considered statistically significant.Results A total of 20 patients were selected,including 16 males and 4 females,aged 46 to 68 years,with an average of 54.1 years old.The area of the peroneal artery perforator flap was 6.0 cm×7.0 cm—6.5 cm×8.0 cm,and the length of the pedicle was 6.0 cm—7.0 cm.The overall survival rate of the flap was approximately 95.0%(19/20).The survival rates of 1,2,and 3 years after operation were 95.0%,73.7%,and 64.3%,and the tumor-free survival rates were 95.0%,63.2%,and 57.1%.With the prolongation of postoperative time,the functions of swallowing,speech and chewing gradually improved,and there was a statistically significant difference in 6 months after operation compared with 3 months after operation(P<0.05).Speech was improved 12 months after operation compared to 6 months after operation.The difference was statistically significant(P<0.05).Conclusions The research showed that the peroneal artery perforator exhibited a constant anatomic location,and its diameter and length were more suitable for the preparation of free perforator flaps.The posterolateral tissues of lower legs are abundant,which is beneficial for repairing full tongue and subtotal tongue defects.The recovery of functions such as swallowing,speech intelligibility and chewing was ideal.