血管化游离组织瓣在口腔颌面—头颈部缺损修复中的应用(4640例临床分析)  

Application of vascularized free flap in reconstruction of oral and maxillofacial-head and neck defect: A clinical analysis of 4640 cases

作　　者：徐立群[1] 张陈平[1] 张志愿[1] 孙坚[1] 竺涵光[1] 唐友盛[1] 沈国芳[1] 季彤[1] 杨雯君[1] 何悦[1] 胡永杰[1] 叶为民[1] 李军[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科,上海200011

出　　处：《实用肿瘤杂志》2015年第1期18-21,共4页Journal of Practical Oncology

摘　　要：目的探讨血管化游离组织瓣修复口腔颌面—头颈部缺损的应用价值。方法收集4 481例应用血管化游离组织瓣修复重建患者资料,对其构成比、发展趋势、一线组织瓣特点、皮瓣危象发生率与成功率等进行系统分析总结。采用Microsoft Excel(2010 version)软件进行数据的统计学分析。结果共制备4 640例血管化游离组织瓣,平均年龄58.6岁,男女比例1.6∶1,良、恶性比例1∶3。舌(25.1%)、下颌骨(16.0%)、口底(13.4%)、颊(12.7%)缺损修复占总数的67.2%。前臂皮瓣(55.6%)、腓骨组织瓣(13.5%)、股前外侧穿支皮瓣(10.1%)应用占皮瓣总数的79.2%。419例皮瓣危象发生,成功抢救皮瓣305例,皮瓣危象总发生率为9.0%,危象抢救成功率72.8%,皮瓣总成功率达97.5%。结论血管化游离组织瓣成功率高,应用安全可靠;针对不同缺损特点,采用合适组织瓣修复,对患者功能与外形重建具有重要意义;前臂皮瓣、腓骨组织瓣与股前外侧穿支皮瓣为口腔颌面头颈部缺损修复的常用组织瓣。Objective To review the application of vascularized free flap for the reconstruction of oral and maxillofacial-head and neck defects. Methods Clinical data of 4 481 cases receiving vascularized free flap reconstruction were retrospectively reviewed. The ratio of constitution,time trend of development,the features of first line flap,the rate of crisis incidence and the rate of flap survival were analyzed with Microsoft Excel（ 2010 version）. Results A total of 4 640 free flaps were harvested. The average age of patients was 58. 6 years; the ratio of male to female was 1. 6∶ 1 and the ratio of benign to malignant underlying diseases was 1 ∶ 3. The defects of tongue（ 25. 1%）,mandible（ 16. 0%）,mouth floor（ 13. 4%） and cheek（ 12. 7%） accounted for 67. 2% in this series. Radial forearm flap（ RFF,55. 6%）,free fibula flap（ FFF,13. 5%） and anterior lateral thigh perforator flap（ ALT,10. 1%） accounted for 79. 2% of all the flaps. The incidence rate of flap crisis was 9. 0%（ 419 /4 640）,among which 305 flaps were saved with a salvage survival rate of72. 8%（ 305 /419） and a total survival rate of 97. 5%（ 4 526 /4 640）. Conclusion Vascularized free flap has a high success rate when applied in the reconstruction of oral and maxillofacial-head and neck defects. Radial forearm flap,free fibula flap and anterior lateral thigh perforator flap are most frequently applied in this series.

关 键 词：口腔/损伤 面部损伤/外科学 外科皮瓣 颌/损伤 颈部损伤/外科学 头部/外科学 修复外科手术 

分 类 号：R782.2[医药卫生—口腔医学]