BrownⅡ类上颌骨缺损患者不同修复方式的远期生存质量分析

Long-term quality of life in patients with BrownⅡmaxillary defect repaired by different methods

目的分析比较组织瓣和赝复体修复重建上颌骨BrownⅡ类缺损患者的远期生存质量。方法选取2014—2017年期间于蚌埠医学院第一附属医院行上颌骨恶性肿瘤手术治疗的患者,采用第四版华盛顿大学生存质量问卷(University of Washington Quality of Life Questionnaire,UW-QOL)调查术后远期(>5年)生存质量,采用Mann-Whitney U检验组间差异性。结果本研究失访4例,死亡9例,共收回有效问卷46份,其中男24例,女22例,年龄19~86岁。BrownⅡb/c类26例,BrownⅡd类20例;行组织瓣重建29例(即组织瓣重建组),赝复体修复17例(即赝复体组)。赝复体组咀嚼QOL得分优于组织瓣重建组(Z=-2.787,P=0.005),但娱乐、吞咽、语言、情绪QOL得分不如组织瓣重建组(Z值分别为-3.185、-2.091、-2.556、-1.996,P值均<0.05)。在BrownⅡb/c类中,赝复体修复能提高咀嚼QOL得分(Z=-2.830,P=0.005),其他QOL得分及平均分差异无统计学意义;在BrownⅡd类中,组织瓣重建能改善疼痛、娱乐、吞咽、语言QOL得分(Z值分别为-2.741、-2.517、-2.320、-2.843,P值均<0.05),且平均QOL得分优于赝复体修复(Z=-2.276,P=0.023)。结论就远期效果而言,对于BrownⅡb/c类缺损患者,赝复体修复与组织瓣重建修复均能达到较满意的效果;对于BrownⅡd缺损患者,组织瓣重建有更好的语音、吞咽功能。组织瓣重建可能会带来更多娱乐、情绪方面的助益。

Objective To analyze the long-term quality of life of patients with BrownⅡmaxillary defect repaired by tissue flap or prosthesis.Methods Patients who underwent surgery for maxillary malignant tumors in the First Affiliated Hospital of Bengbu Medical College from 2014 to 2017 were selected to investigate the postoperative long-term(>5 years)quality of life using the fourth edition of the University of Washington quality of life questionnaire(UW-QOL).Mann Whitney U test was used to examine the differences between two groups.Results In this study,4 cases were lost to follow-up,9 died,and a total of 46 valid questionnaires were collected,including 24 males and 22 females,aged 19-86 years.There were 26 cases of classⅡb/c and 20 cases of classⅡd.Tissue flap reconstruction was performed in 29 cases(tissue flap group)and prosthesis restoration in 17 cases(prosthesis group).The score of chewing QOL in the prosthesis group was higher than that in the tissue flap reconstruction group(Z=-2.787,P=0.005),but the scores of entertainment,swallowing,speech and emotion QOL in the former group were respectively lower than those in the latter group(Z=-3.185,-2.091,-2.556 and-1.996,respectively,all P values<0.05).In patients with BrownⅡb/c defect,the prosthesis repair could improve the chewing QOL score(Z=-2.830,P=0.005),but no statistically significant differences in other QOL scores between two groups.In patients with BrownⅡd defect,the tissue flap reconstruction could improve the scores of pain,entertainment,swallowing and speech QOL(Z=-2.741,-2.517,-2.320 and-2.843,respectively,all P values<0.05),and the average QOL score in tissue flap reconstruction group was also higher than that of the prosthesis group(Z=-2.276,P=0.023).Conclusion For postoperative long-term quality of life,both prosthesis and tissue flap reconstruction can offer satisfactory results in patients with BrownⅡb/c defect,and patients with BrownⅡd defect repaired by tissue flap reconstruction have better speech and swallowing functions.Tissue flap reconstruction may bring more entertainment and emotional benefits.