游离组织瓣修复口腔颌面部组织缺损术后血管危象的相关因素分析  

Risk factors of vascular crisis of free tissue flap after the repairation of oral and maxillofacial tissue defect

作　　者：陈昊亮 孙国文[1] 陈欣[1] 周婷[1] 胡勤刚[1] 文建民[1] CHEN Haoliang;SUN Guowen;CHEN Xin;ZHOU Ting;HU Qin'gang;WEN Jianmin(Department of Oral and Maxillofacial Surgery,Nanjing Stomatological Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属口腔医院,南京市口腔医院口腔颌面外科210008

出　　处：《中华显微外科杂志》2020年第4期347-352,共6页Chinese Journal of Microsurgery

摘　　要：目的探讨游离组织瓣修复口腔颌面部组织缺损术后血管危象的转归情况,并分析相关因素。方法2013年1月至2018年7月,游离组织瓣修复口腔颌面部组织缺损1049例,其中术后发生血管危象共64例,对其临床资料进行回顾性分析,其中前臂皮瓣(RFFF)28例、股前外侧皮瓣(ALTF)19例、腓骨瓣17例。所有患者均接受了血管危象探查术。对可能的相关危险因素使用SPSS 22.0软件包分别进行单因素分析和多因素分析,P<0.05为差异有统计学意义。结果64例手术挽救成功44例(68.8%)。单因素分析显示,吸烟、组织瓣类型、危象发生时间、间隔时间(发生血管危象至进行手术探查的间隔时间)和引起危象原因与组织瓣抢救成功率具有相关性(P<0.05)。多因素分析显示,组织瓣类型、危象发生时间、间隔时间是影响组织瓣抢救成功率的独立危险因素(P<0.05)。结论危象发生越早,间隔时间越短,组织瓣危象的抢救成功率越高;组织瓣类型会影响组织瓣危象的抢救成功率,前臂皮瓣、股前外侧皮瓣和腓骨瓣的抢救成功率依次降低;尽早识别血管危象并进行手术探查是组织瓣抢救的首要原则。Objective To analyse clinical outcomes and risk factors of vascular crisis on patients received oral and maxillofacial defect repairations with free tissue flap.Methods From January,2013 to July,2018,1049 patients with soft tissue defect of oral and maxillofacial were reconstructed with free tissue flap,in which 64 cases occurred vascular crisis.Among the cases,28 defect were reconstructed with radial forearm free flap(RFFF),19 with anterolateral thigh flap(ALTF),and 17 with fibula flap.All patients underwent surgical exploration.The clinical data and surgical outcomes were collected.The univariate analysis and multivariate regression analysis were performed by using SPSS version 22.0 software.The result was supposed to statistically significant when P<0.05.Results Among 64 patients occurred vascular crisis,44 flaps were rescued successfully by surgical procedures(68.8%).Univariate analysis revealed that the salvage rate was related to the smoking history,type of tissue flap,time of vascular crisis occurrence,cause of vascular crisis and the time interval between crisis occurrence and surgical exploration(P<0.05).Multivariate regression analysis revealed that only type of tissue flap,the time of vascular crisis occurrence and the interval time were the independent significant factors for salvage rate(P<0.05).Conclusion The salvage rate became higher when the vascular crisis occurred earlier,and the interval time was shorter.The type of tissue flap could affect the outcome of surgical exploration.The success rate decreased with an order of RFFF,ALTF to fibula flaps.The primary principle in the management of vascular crisis was early identification and early surgical exploration.

关 键 词：组织瓣 腓骨瓣 血管危象 危险因素 颌面部组织缺损 显微外科技术 

分 类 号：R782[医药卫生—口腔医学]