分叶穿支皮瓣在口腔黏膜下纤维性变癌变手术治疗中的应用  

Application of polyflaps perforator flaps in surgical treatment of malignant conversion of oral submucous fibrosis

作　　者：陈洁[1] 蒋灿华[1] 杨龙[1,2] 翦新春[1] 郭峰[1] 李宁[1] 

机构地区：[1]中南大学湘雅医院口腔颌面外科,长沙410008 [2]长沙市中心医院

出　　处：《中国医师杂志》2015年第9期1305-1308,1313,共5页Journal of Chinese Physician

摘　　要：目的 探讨口腔黏膜下纤维性变（OSF）癌变的临床特点和分叶穿支皮瓣在其手术治疗中的应用价值.方法 2012年8月至2014年10月,采用分叶股前外侧穿支皮瓣一期修复10例OSF癌变根治术后形成的多部位软组织缺损.除完成OSF癌变病灶的根治外,同时切除翼下颌韧带处限制张口的纤维条索和口内其他具有癌变倾向的黏膜病变;口腔多原发癌患者同期行其他癌变病灶的根治和颈部淋巴结清扫.根据形成的缺损数目及大小在相邻穿支间对皮瓣进行裁剪,形成多个皮岛分别用于修复多处软组织缺损.结果 10例OSF癌变患者根治术后共形成22处软组织缺损,均同期采用分叶股前外侧穿支皮瓣进行修复,其中二分叶皮瓣8例,三分叶皮瓣2例.皮瓣总面积3 cm×8cm～6cm×24cm,血管蒂长度5～12（9.7 ±2.1）cm;共解剖出穿支35组,平均每块皮岛含穿支1.6组.皮瓣移植后均完全成活,1例患者术后5d颈部切口发生感染,2例出院后行辅助放化疗.术后随访6 ～30（11.6±3.7）个月,患者受区外形及语音、吞咽功能恢复良好,张口度明显改善.1例患者术后10个月死于肺部转移,其他患者未发生复发及远处转移.供区均一期关闭且无明显手术并发症发生.结论 分叶穿支皮瓣能一期修复多部位、大范围的复杂组织缺损,有效增加患者开口度,在OSF癌变的手术治疗中具有应用价值.Objective To investigate the clinical features of malignant conversion of oral submucous fibrosis （OSF） and the application value of polyflaps perforator flaps in its surgical treatment.Methodis Ten patients who suffered from malignant conversion of OSF underwent simultaneous multiple defects reconstruction using polyflaps perforator flaps after radical tumor resection from August 2012 to October 2014.The fibrous bands leading to severe trismus near the pterygomandibular ligament as well as other intraoral lesions with malignant tendency were also resected besides from the known carcinoma.Patients with synchronous multiple primary cancers underwent radical resection and neck dissection of all other malignant lesions.The flaps were cut and tailored between adjacent perforators according to the amount and size of defects,forming several independent paddles for each defect reconstruction.Results Twenty-two defects were formed in 10 patients with malignant conversion of OSF.All of them were repaired with polyflaps anterolateral thigh （ALT） perforator flaps,including 8 cases of bipaddled ALT flaps and 2 cases of tripaddled ALT flaps.The total size of the flaps ranges from 3 cm ～ 8 cm × 6 cm ～ 24 cm,and the pedicle length ranges from 5 ～ 12 （9.7 ± 2.1）cm.Thirty-five perforator vessels were dissected,and each paddle included 1.6 perforators on average.All flaps survived after transplantation,and only 1 patient had infection of the neck incision.Post-operative adjuvant radio-chemotherapy was applied in 2 patients.All patients showed satisfactory accepting-site morphology with good speech function and swallowing recovery,and their trismus was improved during 6 to 30 （11.6 ± 3.7） months.One patient died from lung metastasis 10 months after the surgery while local recurrent or metastasis did not occur in others.The donor sites were closed primarily without skin-grafting,leaving no obvious surgical donor-site complications.Conclusions Polyflaps perforator flaps can reconstruct multiple and sizable co

关 键 词：口腔黏膜下纤维化/外科学 外科皮瓣 

分 类 号：R739.8[医药卫生—肿瘤]