游离股前外侧皮瓣与改良胸大肌皮瓣在修复头颈肿瘤术后缺损中的选择与改进  

Selections and improvements in reconstruction of defects after head and neck tumor resection with anterolateral thigh free flap or modified pectoralis major myocutaneous flap

作　　者：蔡旭 喻建军[1,2] 李赞[2] 周晓[1,2] 宋波[3] 谌星[1,2] 左良[1,2] 王鸿涵[1,2] 高水超 田皞[1,2] Cai Xu;Yu Jianjun;Li Zan;Zhou Xiao;Song Bo;Chen Xing;Zuo Liang;Wang Honghan;Gao Shuichao;Tian Hao(The Second Department of Head&Neck Surgery,Hunan Cancer Hospital&The Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410013,China;Department of Oncoplastic Surgery,Hunan Cancer Hospital&The Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410013,China;Department of Diagnostic Radiology,Hunan Cancer Hospital&The Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410013,China)

机构地区：[1]湖南省肿瘤医院头颈外二科,长沙410013 [2]湖南省肿瘤医院肿瘤整形外科,长沙410013 [3]湖南省肿瘤医院放射诊断科,长沙410013

出　　处：《中华整形外科杂志》2020年第3期284-288,共5页Chinese Journal of Plastic Surgery

基　　金：湖南省自然科学基金(2018JJ2244)。

摘　　要：目的探讨游离股前外侧皮瓣与改良胸大肌皮瓣在头颈肿瘤术后缺损修复中的应用及效果。方法2011年11月至2016年11月湖南省肿瘤医院头颈外科收治头颈部肿瘤患者394例,男性286例,女性108例,年龄25~79岁。分别采用游离股前外侧皮瓣(306例)、改良胸大肌皮瓣(88例)修复头颈肿瘤术后缺损。采用t检验法分析不同方法修复的效果及患者生存质量,总结2种皮瓣修复的优缺点及适应证。结果本组394例,游离股前外侧皮瓣组皮瓣成活率97.1%(297/306),改良胸大肌皮瓣组成活率97.7%(86/88);手术总时间2组相近,游离股前外侧皮瓣组3~4 h,改良胸大肌皮瓣组1.5~2.5 h;术后1年,UW-QOL评分游离股前外侧皮瓣组与胸大肌皮瓣组相比,在外观、言语功能及肩部运动方面有显著优势,差异有统计学意义(P<0.05)。结论头颈部肿瘤术后缺损修复中,游离股前外侧皮瓣及改良胸大肌皮瓣都具有较高的成功率,游离股前外侧皮瓣适用于复杂缺损的修复,改良胸大肌皮瓣对血管条件、全身状况不佳的患者,更具有安全性。Objective To explore the application and effect of anterolateral thigh free flap(ALTFF)and modified pectoralis major myocutaneous flap(PMMF)in the reconstruction of defects after radical resection of head and neck tumor.Methods From November 2011 to November 2016,394 cases with head and neck tumor,including 286 males and 108 females,aged 25-79 years,underwent radical resection.The defect was reconstructed with anterolateral thigh free flap(306 cases)or modified pectoralis major myocutaneous flap(88 cases).The result and the quality of life of patients are investigated,the advantages and disadvantages of the two flaps are summarized.Results Survival rate of anterolateral thigh free flap and modified pectoralis major myocutaneous flap were 97.1%(297/306)and 97.7%(86/88)in 394 cases.The ALTFF group(3-4 h)and the PMMF group(1.5-2.5 h)have similar operative duration.Comparison of the UW-QOL scores of the ALTFF group and PMMF group 1 year post operation shows that the ALTFF group has significant advantages in appearance,speech and shoulder mobility,the difference was statistically significant(P<0.01).Conclusions Both of ALTFF group and PMMF group have high success rate in the reconstruction of defects after radical resection of head and neck tumor.Anterolateral thigh free flap is appropriate for the reconstruction of complex defects and modified pectoralis major myocutaneous flap is safer in patients with poor vascular conditions and systemic conditions.

关 键 词：游离股前外侧皮瓣 胸大肌皮瓣 头颈肿瘤 肿瘤整形外科 

分 类 号：R73[医药卫生—肿瘤]