自体组织移植修复上颌骨缺损的临床疗效观察

Clinical observation of autologous tissue transplantation for repairing maxillary defect

目的:探讨Ⅱ期中空充填式赝复体和血管化髂骨-腹内斜肌复合组织瓣移植修复全上颌骨缺损的面部结构与功能重建效果。方法:选取我院颌面外科收治的行上颌骨全切手术的上颌窦癌患者41例,根据全上颌骨缺损Ⅱ期重建的修复方法不同分为A、B两组。A组患者23例,使用中空充填式赝复体修复;B组患者18例,使用塑形的血管化髂骨-腹内斜肌复合组织瓣修复。术后随访1年,观察患者修复后面容、语音清晰度、吞咽与咀嚼功能恢复情况及并发症发生情况。结果:修复术后1年,A组语音清晰度为(94.52±9.31)%低于B组的(95.71±8.49)%,差异无统计学意义(P>0.05)。A组面部凹陷与眼球下坠数值分别为(82.57±3.16)mm、(2.25±0.72)mm,B组分别为(81.44±3.53)mm、(2.19±0.67)mm,两组差异均无统计学意义(P>0.05)。A组患者吞咽功能提高至Ⅱ级,B组患者吞咽功能提高至Ⅰ级,B组吞咽功能恢复更好。A、B两组咀嚼功能评分分别为(25.93±3.29)和(27.01±2.78),差异有统计学意义(P<0.01)。结论:血管化复合组织瓣修复全上颌骨缺损在咀嚼功能恢复方面优于赝复体修复,对于面部外形和语音、吞咽功能恢复的效果相近。

Objective:To investigate the effect and clinical value of facial replenishment and vascularized iliac-abdominal oblique muscle flap transplantation in repairing all maxillary defects.Methods:Forty-one patients with maxillary sinus carcinoma who underwent maxillary total resection were treated with maxillofacial surgery.All of them were divided into A and B groups according to the reconstruction method of total maxillary defect.There were 23 patients with group A and group A were treated with hollow filling prosthesis.There were 18 patients in group B who were treated with vascularized iliac-abdominal oblique composite flap.The patients were followed up for 1 year.The recovery of the patient,voice clarity,recovery of swallowing and chewing function and the occurrence of complications were observed.Results:The speech intelligibility of group A was(94.52±9.31)%after 1 years of repair,which was lower than that of group B(95.71±8.49)%,and the difference was not statistically significant(P>0.05).The values of facial depression and eyeball drop in group A were(82.57±3.16)mm and(2.25±0.72)mm,and those in group B were(81.44±3.53)mm and(2.19±0.67)mm respectively,and there was no significant difference between them(P>0.05).The swallowing function of group A was increased to grade II,and the swallowing function of group B was increased to grade I,and the swallowing function of group B was better.The scores of chewing function were(25.93±3.29)and(27.01±2.78)in A and B group,and the difference was statistically significant(P<0.01).Conclusion:The vascularized composite flap is superior to the prosthesis in the restoration of masticatory function,and has similar effect on the facial contour,speech and swallowing function.