晚期舌癌手术患者行薄型股前外侧皮瓣修复术的疗效及术后发生吞咽功能障碍的影响因素分析

Efficacy of thin anterolateral thigh flap repair and analysis of influencing factors of postoperative swallowing dysfunction in patients with advanced tongue cancer undergoing surgery

目的探讨晚期舌癌手术患者行薄型股前外侧皮瓣修复术的疗效及术后发生吞咽功能障碍的影响因素。方法收集60例晚期舌癌手术患者的病历资料,根据手术方法的不同分为对照组(n=28,行锁骨上皮瓣修复术)和观察组(n=32,行薄型股前外侧皮瓣修复术)。术后对两组患者随访6个月,比较两组患者的手术相关指标。根据术后6个月是否存在吞咽功能障碍将晚期舌癌患者分为有吞咽功能障碍患者和无吞咽功能障碍患者,并采用Logistic回归模型分析晚期舌癌患者术后发生吞咽功能障碍的影响因素。结果观察组患者的手术时间、伤口愈合时间均短于对照组,术后吞咽功能障碍发生率低于对照组,差异均有统计学意义(P﹤0.05)。有吞咽功能障碍与无吞咽功能障碍患者年龄、TNM分期、舌体缺损范围、合并基础疾病情况、吸烟史、皮瓣手术位置比较,差异均有统计学意义(P﹤0.05)。多因素Logistic回归分析结果显示,年龄≥60岁、TNM分期为Ⅳ期均是晚期舌癌患者术后发生吞咽功能障碍的独立危险因素(P﹤0.05)。结论对晚期舌癌手术患者采用薄型股前外侧皮瓣修复术能够对患者舌体缺损部位进行有效修复重建,缩短手术时间和伤口愈合时间,降低术后吞咽功能障碍的发生率。年龄≥60岁、TNM分期为Ⅳ期均是晚期舌癌患者术后发生吞咽功能障碍的独立危险因素。

Objective To explore the efficacy of thin anterolateral thigh flap repair and the influencing factors of postoperative swallowing dysfunction in patients with advanced tongue cancer undergoing surgery.Method The medical records of 60 patients with advanced tongue cancer who underwent surgery were collected and divided into control group(n=28,suclavicular flap repair)and observation group(n=32,thin anterolateral thigh flap repair)according to different surgical methods.All patients were followed up for 6 months after operation,and the operation-related indexes of the two groups were compared.Patients with advanced tongue cancer were divided into patients with and without swallowing dysfunction according to whether they had swallowing dysfunction 6 months after surgery.Logistic regression model was used to analyze the influencing factors of swallowing dysfunction in patients with advanced tongue cancer.Result The operation time and wound healing time of observation group were shorter than those of control group,and the incidence of postoperative swallowing dysfunction was lower than that of control group,the differences were statistically significant(P<0.05).There were significant differences in age,TNM stage,tongue defect range,combined underlying diseases,smoking history and flap operation location between patients with and without swallowing dysfunction(P<0.05).Multi-variate Logistic regression analysis showed that age≥60 years old and TNM stage IV were independent risk factors for postoperative swallowing dysfunction in patients with advanced tongue cancer(P<0.05).Conclusion Thin anterolateral thigh flap repair can effectively repair and reconstruct the tongue defect in patients with advanced tongue cancer undergoing surgery,shorten the operation time and wound healing time,and reduce the incidence of postoperative swallowing dysfunction.Age≥60 years old and TNM stage IV are independent risk factors for postoperative swallowing dysfunction in patients with advanced tongue cancer.