头颈部游离复合组织瓣移植的临床研究  

Free composite flap transfers in the head and neck region: an 8-year experience

作　　者：毛驰[1] 俞光岩[1] 彭歆[1] 张雷[1] 郭传瑸[1] 黄敏娴[1] 张益[1] 马大权[1] 

机构地区：[1]北京大学口腔医学院.口腔医院口腔颌面外科,北京100081

出　　处：《北京大学学报（医学版）》2008年第1期64-67,共4页Journal of Peking University:Health Sciences

摘　　要：目的:探讨应用游离组织瓣移植修复头颈部缺损的可行性和可靠性。方法:对1999年5月至2007年9月期间由同一手术小组完成的1501例头颈部游离组织瓣移植的病例进行回顾性研究,其中男性918例,女性583例,年龄最小5岁,最大86岁,平均45.8岁,共使用腓骨瓣、前臂皮瓣、腹直肌皮瓣、空肠瓣、大腿前外侧皮瓣、上臂外侧皮瓣、背阔肌皮瓣、肩胛皮瓣和回盲瓣等10种游离组织瓣,共1584块游离组织瓣,分析所采用组织瓣的受区血管、游离组织瓣成活情况及术后血管危象的发生及处理情况,并分析有可能影响游离组织瓣成活的各种因素。结果:腓骨瓣、前臂皮瓣、腹直肌皮瓣、空肠瓣和大腿前外侧皮瓣为最常用的5种游离组织瓣,占全部游离组织瓣的96.8%(1534/1584);本组游离组织瓣的临床成功率为98.1%(1554/1584),游离组织瓣术后血管危象的发生率为3.3%(53/1584),其中静脉危象占75.5%(40/53),动脉危象占24.5%(13/53),血管危象的抢救成功率为43.4%(23/53)。结论:头颈部游离组织瓣移植安全可靠,简化的头颈显微外科技术值得进一步被应用和推广。Objective： To analyze the feasibility and reliability of free tissue flap transfers in the head and neck region. Methods： One thousand five hundred and eighty-four consecutive free flap transfers performed in 1 501 patients from May 1999 to September 2007 were reviewed. Among the 1501 patients, 918 were male and 583 were female. The age range was 5 to 86, with the average of 45.8 years. Data concerning the operation included date of surgery, defect description and site, stage and histology of tumor, flap type, recipient vessel, rate of postoperative vessel thrombosis and salvage rate. Results： There were ten kinds of free flaps in this group, with the free fibula flap most commonly used, followed by free radial forearm flap, rectus abdominis flap, free jejunum flap, anterolateral thigh free flap, iliac crest flap, scapular flap, latissimus dorsi flap, lateral arm flap, and ileocecal flap. The overall success rate of flaps was 98.1% （ 1 554/1 584）. Fifty-five cases developed vessel thrombosis after operation, 40 were venous and 13 were arterial. The rate of vessel thrombosis was 3.3% （53/1 584） , and the salvage rate was 43.4% （23/53）. Conclusion： Free tissue flap transfer in the head and neck region is feasible and reliable, and further application of simplified technique of head and neck microsurgery is necessary.

关 键 词：颈 外科皮瓣 移植物存活 显微外科手术 

分 类 号：R782.24[医药卫生—口腔医学]