单侧Gillies扇形瓣结合口周肌群重建修复鳞癌切除术后下唇缺损  

Dynamic reconstruction of lower lip defect after cancer resection by using unilateral Gillies fan flap and perioral muscles restoration

作　　者：苏若为 乔嘉 关丽梅[1] 蔡巧玲[1] 骆献阳[1] 牛峰 Su Ruoivei;Qiao Jia;Guan Limei;Cai Qiaoling;Luo Xianyang;Niu Feng(Division of Craniomaxillofacial Surgery,Department of Otolaryngology Head&Neck Surgery,the First Affiliated Hospital of Xiamen University,Xiamen 361003,China;Department of Craniomaxillofacial Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Science,Peking Union Medical College,Beijing 100144,China)

机构地区：[1]厦门大学附属第一医院耳鼻咽喉头颈外科口腔颅颌面外科,361003 [2]中国医学科学院北京协和医学院整形外科医院颅颌面外科,100144

出　　处：《中华整形外科杂志》2020年第12期1341-1349,共9页Chinese Journal of Plastic Surgery

摘　　要：目的探讨单侧Gillies扇形瓣结合口周肌群重建修复鳞癌切除术后下唇缺损的临床效果。方法2017年2月至2020年1月,厦门大学附属第一医院耳鼻咽喉头颈外科收治8例下唇鳞状细胞癌患者,男2例,女6例,年龄55~81岁,平均62.9岁,采用单侧Gillies扇形瓣结合口周肌群重建的方法修复鳞癌切除术后下唇中度缺损。设计Gillies扇形瓣所包含的上唇唇红长度为下唇缺损唇红长度的1/3,制备以对侧上唇动脉-同侧上唇动脉-面动脉口角段-同侧下唇动脉供血的轴型复合组织瓣,旋转修复下唇缺损。解剖时留存口周各辐射肌群断端备用,恢复口轮匝肌连续性后,在重建口唇对应处固着各口周辐射肌止点。术后行口周肌群肌力训练,待口唇唇长和形态趋于稳定后,进行测量、计算,评价唇外观、张口功能、闭合功能。结果本组8例患者上、下唇唇红长度平均52.4 mm(46.0~60.0 mm);口唇唇红周长平均104.8 mm(92.0~120.0 mm),下唇缺损范围平均27.6 mm(21.0~35.0 mm),占下唇唇红52.5%(42.0%~67.3%),使用右侧Gillies扇形瓣6例,左侧2例,包含唇红长度平均9.5 mm(7.0~12.0 mm)。术后无感染、出血、血肿等手术并发症发生,切口愈合好,瘢痕相对不明显,存在不同程度下唇麻木感;随访6个月,唇癌无局部或远处复发,下唇麻木感逐渐消失。根据术前及术后6个月测量结果进行评价:(1)唇外观:所有病例术后口唇形态自然,居中对称,两侧口角基本水平对称。上、下唇唇长有不同程度延长,上唇平均增加量6.8 mm,增加率15.9%;下唇平均增加量15.4 mm,增加率45.3%;静息时口唇唇红周长较术前平均减少5.5 mm,为术前周长94.9%,基本恢复术前水平。(2)张口功能:所有病例术后1周张口形为偏斜类圆形,张口度约1.5横指,术后6个月,张口形呈基本对称类圆形,张口度3横指;最大张口时口唇唇红周长较术前平均减少46.5 mm,为术前最大张口周长73.1%,基本满足生理需要。(Objective To study the clinical effect of dynamic reconstruction of lower lip defect after squamous cell cancer resection by using unilateral Gillies fan flap and perioral muscle restoration.Methods From Feburary 2017 to January 2020,8 patients(6 female and 2 male,aged 55-81,62.9 in average)diagnosed lower lip squamous cell carcinoma were accepted treatment in the Department of Otolaryngology Head&Neck Surgery,the First Affiliated Hospital of Xiamen University.All the moderate lower lip defect after cancer resection were repaired with unilateral Gillies fan flap with perioral muscle restoration under general anesthesia.The length of the vermilion of the upper lip in the Gillies fan flap was designed to be 1/3 of the length of the vermilion of the lower lip defect.The composite axial flap was prepared with the blood supply from contralateral upper lip artery-ipsilateral upper lip artery-mouth corner part of facial artery-ipsilateral lower lip artery.The end of all the perioral muscles were also prepared.After reconstruction of the continuity of the orbicularis oris,the ends of these perioral radiation muscles were restored in the position where they should be in the reconstructed lip.These perioral muscles training were undergone for 6 months after operation.After the reconstructed lip tend to be stable,measurement and calculation were carried out to evaluate the appearance,opening and closing functions of the mouth.Results In our series of 8 cases,the length of the vermilion of the upper/lower lip was 52.4 mm(46.0-60.0 mm)in average;the circumference of the vermilion was 104.8 mm(92-120 mm)in average;the length of the defect of lower lip was 27.6 mm(21.0-35.0 mm)in average,52.5%(42.0-67.3%)of the vermilion of lower lip.Six cases were using the right-side flap,and the other 2 cases were left.The length of the vermilion of the upper lip in the Gillies fan flap was 9.5 mm(7.0-12.0 mm)in average.All cases healed well with inconspicuous scar.No infection,hematoma or other surgical complications.No local or distant rec

关 键 词：唇肿瘤 修复外科手术 Gillies扇形瓣 

分 类 号：R739.8[医药卫生—肿瘤]