144例头颈部游离组织瓣移植患者的临床分析

A Review of 144 Patients in Head and Neck Reconstruction by Consecutive Free Flap Transfers

目的:探讨采用头颈部游离组织瓣移植行头颈部重建的效果。方法:对1999年5月～2000年10月采用游离组织瓣移植行头预部重建的144例患者作回顾性研究,分析采用组织瓣的类型、受区血管、血管吻合方式和技术、组织瓣成活情况及术后并发症的发生情况。结果:前臂皮瓣、腓骨瓣和腹直肌瓣为最常用的行头颈部重建的游离组织瓣,占全部皮瓣的94.7％;游离组织瓣移植的成功率为98％,术后血栓的发生率为6％,抢救成功率为66.7％;受区和供区总的并发症发生率为34％,但大多数并发症均不严重,没有造成明显的后果;吸烟、饮酒、放疗和患者年龄等均非影响游离组织瓣移植成功的重要因素。结论:头颈部游离组织瓣移植安全可靠,且优于传统的带蒂组织瓣移植,是头颈部重建的合理选择。

Objective:The aim of this study was to evaluate the effects of different free flap transfers for head and neck reconstruction in a new microsurgery unit. Methods: 150 consecutive free flap transfers performed in 144 patients from May 1999 to October 2000 were reviewed. Data concerning the operation included date of surgery, defect description and site, stage and histology of tumor, flap type, recipient vessel and type of anastomosis used and complications. Results: The free radial forearm flaps were the commonest flaps used, and followed by free fibula flaps, rectus abdominis flaps, scapular flaps, illiac crest flaps, and latissimus dorsi flaps. The success rate of all flaps was 98% . The overall complication rate was 34% . The vessel thrombosis rate was 6% , and the flap salvage rate was 66.7% . Conclusion: Free tissue transfer in head and neck region is safe and reliable and, is superior to the conventional pedicled flap technique.