改良胸大肌肌皮瓣与传统胸大肌肌皮瓣修复头颈大型缺损的疗效比较  

Comparison of the effect of modified pectoralis major myocutaneous flap and traditional pectoralis major myocutaneous flap in repairing large defect of head and neck

作　　者：杨光[1] 王洋[2] 张建雅 毛驰[2] 张雷[2] 刘睿[1] 郭玉兴[2] YANG Guang;WANG Yang;ZHANG Jian-ya;MAO Chi;ZHANG Lei;LIU Rui;GUO Yu-xing(The First Hospital of Qiqihar,Oral and Maxillofacial Surgery Department,Qiqihar,Heilongjiang 161000,China)

机构地区：[1]齐齐哈尔市第一医院口腔颌面外科,齐齐哈尔161000 [2]北京大学口腔医院口腔颌面外科,北京100081

出　　处：《中华老年口腔医学杂志》2021年第2期85-89,共5页Chinese Journal of Geriatric Dentistry

基　　金：黑龙江省卫建委课题(项目编号:2019-274)。

摘　　要：目的:本研究目的为比较改良胸大肌肌皮瓣(modified pectoralis major myocutaneous flap,mPMMF与传统胸大肌肌皮瓣pectoralis major myocutaneous flap,PMMF)在修复颌面部及口咽部恶性肿瘤术后大型缺损的效果。方法:本研究纳入28例原发口腔颌面部及口咽部恶性肿瘤患者,行病灶扩大切除术后遗留口腔-咽部大型缺损,分别使用常规胸大肌皮瓣和改良胸大肌皮瓣进行术区组织缺损修复,比较两组患者术中及术后各项指标。结果:改良胸大肌皮瓣及传统胸大肌皮瓣血管蒂的长度分别为18cm^(2)6cm(平均21.6cm)以及17cm^(2)3cm(平均19.3cm)。皮岛的面积分别为5×15到6×28cm^(2)(平均5.3×19.5cm^(2))以及5×7cm^(2)到5×12cm^(2)(平均5.0×8.7cm^(2))。术后随访6个月以上,改良胸大肌皮瓣组患者肩关节活动评分及术后生存质量量表得分均显著高于传统胸大肌皮瓣组,并且颈部外观及功能明显改善。结论:相比传统胸大肌肌皮瓣,改良胸大肌皮瓣的血管蒂更长,面积更大,外形更灵活可以修复多种形状的缺损,副损伤小,颈部外形及功能恢复更好,且术后肩关节活动范围更大,术后功能及生存质量更好,在修复颌面部及口咽部恶性肿瘤术后缺损方面值得进一步推广及应用。Objective:The purpose of this study is to compare the efficacy of modified PMMF(m PMMF)with that of traditional PMMF in reconstructing large defects due to ablative surgery of head and neck malignant tumors.Methods:twenty-eight patients with malignant tumor of head and neck were enrolled in this study and separated into two groups.They all underwent ablative resection with large defects on oral and maxillofacial area left.One group got reconstruction of the large defect by an m PMMF and the other by a traditional PMMF.The indexes of patients from one group were compared with those of the other during and after the surgery.Result:The vascular pedicle lengths of the m PMMF and traditional PMMF were 18-26 cm(average value:21.6 cm)and 17-23 cm(average value:19.3 cm)respectively.And skin paddle dimensions of m PMMF and traditional PMMF ranged from 5 cm×15 cm to 6 cm×28 cm(average value:5.3 cm×19.5 cm)and5 cm×7 cm to 5 cm×12 cm(average value:5.0 cm×8.7 cm)respectively.Within six months’observation,the patients of m PMMF group showed better results in the range of shoulder joint motion and in the quality of life(QOL)as well as better neck appearances and functions than those of traditional PMMF group.Conclusions:Compared with traditional PMMF,MPMMF vascular pedicle is longer,bigger,appearance is more flexible can repair a variety of the shape of the defect,deputy little injury,neck better shape and functional recovery and the postoperative shoulder joint activity range is bigger and better postoperative function and quality of survival,in the repair of maxillofacial and oropharyngeal malignant tumor postoperative defects is worth further promotion and application.

关 键 词：头颈恶性肿瘤 改良胸大肌肌皮瓣 肩关节活动范围 术后生存质量 

分 类 号：R782.2[医药卫生—口腔医学]