腓肠内侧动脉穿支皮瓣修复舌癌术后缺损疗效观察  

MEDIAL SURAL ARTERY PERFORATOR FREE FLAP FOR REPAIR OF DEFECT AFTER TONGUE CANCER ABLATION

作　　者：赵文权[1] 刘建华[1] 刘超[2] 李志勇[1] 

机构地区：[1]浙江大学医学院附属第一医院口腔颌面外,州310003 [2]浙江大学医学院附属口腔医院口腔颌面外科

出　　处：《中国修复重建外科杂志》2015年第3期331-334,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨应用腓肠内侧动脉穿支皮瓣(medial sural artery perforator free flap,MSAP)修复舌癌术后缺损的疗效。方法 2013年3月-2014年4月,采用MSAP修复12例舌癌术后缺损。男7例,女5例;年龄45~68岁,中位年龄55岁。其中高中分化鳞状细胞癌8例,中低分化鳞状细胞癌4例。病程2.0~8.5个月,平均4.3个月。肿瘤部位:舌缘8例;舌腹4例,其中1例浸润口底。TNM分期:T2N0M0 7例,T2N1M0 2例,T3N1M02例,T4N1M0 1例。肿瘤范围3.0 cm×2.0 cm^4.5 cm×3.0 cm。MSAP切取范围4.0 cm×3.5 cm^6.5 cm×6.0 cm。供区切口直接拉拢缝合。结果手术时间5.5~8.3 h,平均6.8 h;皮瓣制备时间54~85 min,平均65.6 min。术后除1例皮瓣发生静脉危象外,其余皮瓣均顺利成活。供区11例切口达Ⅰ期愈合,1例因局部感染经换药后Ⅱ期愈合。患者均获随访,随访时间6~18个月,平均13.7个月。随时间延长,皮瓣表面皮肤逐渐出现黏膜化改变。患者发音逐渐清晰,术后6个月时可基本正常交流。小腿供区未遗留明显瘢痕,均无肢体运动受限等并发症发生。结论 MSAP解剖结构稳定,皮瓣厚薄、质地适宜,应用其修复舌癌术后缺损后舌体外形和语言功能恢复满意,且供区并发症少。Objective To investigate the effectiveness of medial sural artery perforator free flap （MSAP） for repairing defect after tongue cancer ablation. Methods Between March 2013 and April 2014, the defects after tongue carcinoma resection were repaired with MSAP in 12 patients, including 8 cases of high or medium differentiated squamous cell carcinoma （SCC） and 4 cases of moderately-poor differentiated SCC. There were 7 males and 5 females with a median age of 55 years （range, 45-68 years）. The disease duration ranged from 2.0 to 8.5 months （mean, 4.3 months）. The tumor located at the tongue edge in 8 cases and at the tongue abdomen in 4 cases （mouth floor infdtration in 1 case）. According to TNM stage, 7 cases were rated as T^NoM0, 2 cases as T2NIM0, 2 cases as T3NIM0, and 1 case as T4N1M0. The size of tumor ranged from 3.0 cm×2.0 cm to 4.5 cm×3.0 cm. The size of MSAP varied from 4.0 cm×3.5 cm to 6.5 cm×6.0 cm. Results The time of total operation ranged from 5.5 to 8.3 hours （mean, 6.8 hours）, and flap harvesting time ranged from 54 to 85 minutes （mean, 65.6 minutes）. The other flaps survived except 1 case of vein crisis. All the patients were followed up 6-18 months （mean, 13.7 months）. With time passing, the pronunciation got better, and the skin showed mucosa-like change; the patients were capable of normal language exchange at 6 months after operation. No obvious scar on the leg or limitation of limb motion was observed. Conclusion The MSAP is reliable for repair of defect after tongue cancer ablation, with the advantages of satisfactory recovery of tongue appearance, language function, and less donor site morbidity.

关 键 词：腓肠内侧动脉 穿支皮瓣 舌缺损 软组织修复 

分 类 号：R739.86[医药卫生—肿瘤]