172例下颌骨缺损腓骨肌皮瓣修复远期效果评价  

Analysis of long-term prognosis for 172 cases undergoing mandibular reconstruction with free fibular flap

作　　者：王健 何优雅 陈一铭[2] 杨溪[2] 季彤[2] WANG Jian;HE You-ya;CHEN Yi-ming;YANG Xi;JI Tong(Department of Oromaxillofacial Head and Neck Oncology,Fengxian Hospital of Fengxian District,Shanghai Ninth People's Hospital Group. Shanghai 200011;Department of Oromaxillofacial Head and Neck Oncology,Shanghai Ninth People's Hospital,College of Stomatology,Shanghai Jiao Tong University Shool of Medicine,National Clinical Research Center for Oral Disease,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. Shanghai 200011,China)

机构地区：[1]奉贤区奉城医院口腔颌面-头颈肿瘤科,上海九院集团,上海200011 [2]上海交通大学医学院附属第九人民医院·口腔医学院,口腔颌面-头颈肿瘤科,国家口腔疾病临床研究中心,上海市口腔医学重点实验室,上海市口腔医学研究所,上海200011

出　　处：《中国口腔颌面外科杂志》2019年第4期337-341,共5页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的:研究下颌骨缺损腓骨肌皮瓣修复术后远期并发症及危险因素。方法:回顾2011-2013年于上海交通大学医学院第九人民医院口腔-颌面头颈肿瘤科接受下颌骨缺损腓骨肌皮瓣修复患者的基本信息、临床治疗信息、影像学信息、病理学信息、随访记录,采用SPSS17.0软件包对数据进行统计学分析。结果:最终纳入172例患者,其中142例随访信息完整。可随访患者中,19例出现术后远期并发症,中位发生时间为术后8个月。单因素分析时,放疗(包含术前、术后)(P=0.02)、小型钛板(P=0.019)以及疾病性质(P=0.02)与远期并发症发生相关。多因素分析发现,术后放疗(P=0.009)、既往吸烟史(P=0.037)是远期并发症的独立危险因素;二期重建(P=0.069)、术前放疗(P=0.089)的患者、具有发生远期并发症的潜在趋势。结论:术后放疗以及既往吸烟史会导致下颌骨缺损腓骨肌皮瓣修复远期并发症危险增加,应慎用小型钛板。具有远期并发症危险因素的患者,术后6~16个月应该予以密切随访。PURPOSE:To analyze the clinical features and risk factors of late complications for patients who received mandibular reconstruction with free fibular flap.METHODS:A retrospective study of patients undergoing mandibular reconstruction with free fibular flap from 2011 to 2013 in our hospital was reviewed.Demographic,clinical,imaging,pathological and follow-up data were collected and analyzed with SPSS 17.0 software package.RESULTS:Data of 172 patients were collected,142 were followed up.Among 142 patients,19 had late complications,which occurred at a median time of 8 months.Preoperative or postoperative radiotherapy(P=0.02),different type of Ti plates(P=0.019),and the disease characteristics(P=0.02)were significant factors on univariate analysis.Multivariate analysis showed that postoperative radiation(P=0.009)and smoking history(P=0.037)were independent significant factors for late complications.Secondary reconstruction(P=0.069)and preoperative radiotherapy(P=0.086)were potential significant risk factor.CONCLUSIONS:Postoperative radiation and smoking history are associated with late complications.Mini-Ti plate should be used cautiously.Patients with risk factors need to be observed for at least 6 to 16 months before further management.

关 键 词：腓骨肌皮瓣 远期并发症 放疗 吸烟史 

分 类 号：R739.8[医药卫生—肿瘤]