21例儿童头颈部恶性肿瘤患者游离皮瓣修复临床分析  

Free flap reconstruction in 21 pediatric patients with head and neck cancer: clinical considerations for comprehensive care

作　　者：过筠 何优雅 陈一铭[2] 唐妍毅[3] 季彤[2] GUO Yun;HE You-ya;CHEN Yi-ming;TANG Yan-yi;JI Tong(Department of Anesthesiology,Shanghai Stomatological Hospital,Fudan University.Shanghai 200001;Department of Oromaxillofacial Head and Neck Oncology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,College of Stomatology,National Clinical Research Center for Oral Diseases/Shanghai Key Laboratory of Stomatology&Shanghai Research Institute of Stomatology.Shanghai 200011,China)

机构地区：[1]上海市口腔病防治院麻醉科,上海200001 [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,上海200011 [3]上海交通大学医学院附属第九人民医院·口腔医学院口腔综合科,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6期545-549,共5页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的:分析儿童头颈部肿瘤患者术区缺损游离皮瓣修复重建的临床特点。方法:回顾2009—2011年于上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科接受头颈部恶性肿瘤切除以及游离皮瓣修复、年龄≤14岁患者的临床、病理及影像学资料。采用SPSS 17.0软件包对收集的数据进行统计学分析。结果:最终纳入患者21例,其中男14例,女7例;17例为ASAⅠ级,4例为ASAⅡ级。中位手术时间480 min,中位术中出血量500 mL。6例患者接受气管切开。发生内科并发症7例,包括肺部感染4例,腹泻3例;外科并发症4例,包括皮瓣下血肿1例,创面裂开2例,腺瘘1例。气管切开术与内科并发症发生直接相关(P=0.035),与总体并发症(P=0.064)发生具有潜在关联。结论:游离皮瓣对于儿童头颈恶性肿瘤患者术区缺损修复具有极高价值,术后并发症是影响此类患者预后的主要负面因素,气管切开与术后并发症发生关系较大,需谨慎使用。PURPOSE:To analyze the clinical characteristics for free flap reconstruction of defects caused by head and neck cancer among patients aged 14 and below.METHODS:A retrospective study was performed in patients who were treated in the Department of Oromaxillofacial Head and Neck Oncology,Shanghai Ninth People's Hospital from 2009 to 2011,all patients were aged 14 years and below and had reconstructions with free flap for head and neck cancer.Clinical,pathological records and image data were collected and analyzed.SPSS 17.0 software package was used for statistical analysis.RESULTS:Twenty-one patients were finally selected,14 were male and 7 were female;17 patients had ASA score gradeⅠand 4 patients had ASA score gradeⅡ.The median operating time was 480 minutes,and median blood loss was 500 mL.Six patients had tracheotomy,7 had medical complications(4 pulmonary infection,3 diarrhea),4 had surgical complications(1 hematoma beneath flap,2 wound dihescence,1 salivary fistula).Tracheotomy was related to medical complications(P=0.035)and overall complications(P=0.064).CONCLUSIONS:Free flap reconstruction could be applied in pediatric HNC patients.Postoperative complications were main negative factor for prognosis.Tracheotomy had relationship with postoperative complications and should be cautiously used.

关 键 词：儿童 头颈部恶性肿瘤 游离皮瓣重建 

分 类 号：R739.8[医药卫生—肿瘤]