以旋髂深动脉为蒂的髂骨-腹内斜肌筋膜嵌合瓣修复下颌骨口腔黏膜复合缺损  

Application of deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flaps in reconstruction of complex oromandibular defects

作　　者：彭汉伟[1] 林建英[1] 郭海鹏[1] 刘木元[1] PENG Hanwei;LIN Jianying;GUO Haipeng;LIU Muyuan(Department of Head and Neck Surgery,Cancer Hospital of Shantou University Medical College,Shantou Guangdong,515031,P.R.China)

机构地区：[1]汕头大学医学院附属肿瘤医院头颈科,广东汕头515031

出　　处：《中国修复重建外科杂志》2018年第12期1567-1571,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：汕头市科技计划重点项目(2015-132-115)~~

摘　　要：目的探讨以旋髂深动脉为蒂的髂骨-腹内斜肌筋膜嵌合瓣(deep circumflex iliac artery based iliacinternal oblique musculofascial chimeric flap,DCIA-IIOF)修复下颌骨口腔黏膜复合缺损的可行性和疗效。方法 2010年1月—2015年12月,采用DCIA-IIOF修复11例下颌骨口腔黏膜复合缺损患者。其中男8例,女3例;年龄27～75岁,中位年龄56岁。原发疾病:下牙龈癌7例(T3N1M0 2例、T3N2M0 1例、T4N0M0 2例、T4N2M0 2例),鼻咽癌放疗后下颌骨坏死2例,下颌骨中心性鳞癌(T4N0M0)1例,下颌骨恶性纤维组织细胞瘤1例。下颌骨切除后缺损长度7～10 cm,平均8 cm;黏膜缺损面积5 cm×3 cm～7 cm×4 cm。术前彩色超声定位DCIA及其升支,顺行解剖血管制备DCIA-IIOF,其中髂骨瓣修复下颌骨缺损,腹内斜肌及其筋膜修复软组织及黏膜缺损。结果 11例患者均获随访,随访时间15～75个月,中位时间37个月。术后DCIA-IIOF全部成活,均无髂骨瓣及腹内斜肌筋膜瓣坏死发生。1例术后颌下区轻度感染,经引流使用抗生素后痊愈。术后1个月口内腹内斜肌筋膜瓣黏膜化明显,颜色质地与口腔黏膜相近,无明显挛缩,上下颌咬合关系良好。术后6个月2例放疗后下颌骨坏死患者张口改善不明显,接受术后放疗的4例中1例张口受限,其余患者均无张口受限,进食正常。随访期间3例死于肿瘤复发,2例死于其他疾病(脑出血1例、大面积心肌梗死1例),余6例均无瘤生存;均无腹壁疝发生。结论DCIA-IIOF修复下颌骨口腔黏膜复合缺损安全可靠,术后上下颌咬合关系良好,创面质地柔软,是中型下颌骨口腔黏膜复合缺损修复方法之一。Objective To evaluate the reliability and effectiveness of a deep circumflex iliac artery based iliacinternaloblique musculofascial chimeric flap (DCIA-IIOF) in reconstruction of complex oromandibular defect.Methods Between January 2010 and December 2015, DCIA-IIOFs were used to repair complex oromandibular defectsin 11 patients. There were 8 males and 3 females, with an age of 27-75 years (median, 56 years). Original disease was lowergingival squamous cell carcinoma in 7 cases (T3N1M0 in 2 cases, T3N2M0 in 1 case, T4N0M0 in 2 cases, and T4N2M0 in2 cases), osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma in 2 cases, central mandibular squamous cellcarcinoma in 1 case (T4N0M0), and mandibular malignant fibrous histiocytoma in 1 case. The length of mandibular bonedefects ranged from 7 to 10 cm (mean, 8 cm), and the area of the mucosal defects ranged from 5 cm×3 cm to 7 cm×4 cm.Preoperative ultrasonic identification of the DCIA and its ascending branch was routinely performed. The DCIA-IIOF washarvested by using an anterograde dissection technique, of which the iliac island was used for segmental mandibular defectrepair and the musculofascial island for soft tissue and mucosal defect repair. Results All 11 cases were followed up 15-75 months (median, 37 months). All flaps survived after operation, without necrosis of both iliac island and obliqueinternal musculofascial island. One patient had a mild submandibular infection which healed after wound drainageand intravenous antibiotics. At 1 month after operation, the color and texture of the musculofascial island were similar tooral mucosa without contracture, and the occluding relation was good for all patients. At 6 months after operation, themouth opening hardly improved in 2 patients who had osteoradionecrosis; 1 patient who underwent postoperativeradiotherapy had restriction of mouth opening; the remaining 8 patients had normal month opening and normal diet.Three patients died of cancer recurrence, 2 patients died of other diseases (encephalor

关 键 词：下颌骨 旋髂深动脉 髂骨-腹内斜肌筋膜嵌合瓣 口腔肿瘤 

分 类 号：R782.2[医药卫生—口腔医学]