胸背动脉穿支皮瓣在头颈部缺损修复中的临床应用  

Clinical application of thoracodorsal artery perforator flaps in the repair of head and neck defects

作　　者：任振虎[1,2] 范腾飞 游元和[1] 杨雯君 何悦[1] 张陈平[1] 胡镜宙[1] Ren Zhenhu;Fan Tengfei;You Yuanhe;Yang Wenjun;He Yue;Zhang Chenping;Hu Jingzhou(Department of Oral Maxillofacial-Head and Neck Oncology,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine,College of Stomatology,Shanghai Jiao Tong University,National Center for Stomatology,National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology,Shanghai 200011,China;Hainan Western Central Hospital,Academician Zhang Zhiyuan Team Innovation Center,Danzhou 571700,Hainan Province,China;Department of Oral and Maxillofacial Surgery,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]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,上海交通大学口腔医学院国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,200011 [2]海南西部中心医院,张志愿院士团队创新中心,海南省儋州市571700 [3]中南大学湘雅二医院口腔颌面外科,长沙410011

出　　处：《中华耳鼻咽喉头颈外科杂志》2021年第9期914-918,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：海南省卫生健康行业科研项目(20A200079);湖南省自然科学基金青年基金(2020JJ5804);湖南省卫生健康委科研计划课题项目(C2019163);电磁辐射医学防护教育部重点实验室开放课题(2018DCKF003,2019DCKF002)。

摘　　要：目的探讨胸背动脉穿支(thoracodorsal artery perforator,TDAP)皮瓣在头颈部缺损修复中的应用价值。方法回顾性研究方法收集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2017年6月至2018年11月,行口腔及口咽癌根治术并行TDAP皮瓣修复的口腔颌面头颈恶性肿瘤患者38例,其中男32例,女6例,年龄30~74岁。记录并统计患者基本信息,皮瓣大小,血管蒂长度、管径,穿支数量,皮瓣脂肪厚度等信息。皮瓣制备前在患者皮瓣供区应用专业测量仪器Elasti Meter和Skin Fibro Meter测量同一患者TDAP、股前外侧皮瓣、股前内侧皮瓣和前臂皮瓣4种皮瓣供区的皮肤弹性和硬度并进行比较。采用SPSS 19.0统计软件对数据进行统计学分析。结果38例皮瓣全部成活,皮瓣成活率100%。在皮肤弹性方面,TDAP的弹性[(41.2±12.9)N/m]比股前外侧[(77.6±23.3)N/m]、股前内侧[(62.6±17.7)N/m]和前臂皮瓣[(51.7±8.6)N/m]小,差异有统计学意义(χ^(2)值分别为88.89、59.99和37.82,P值均<0.05);在皮肤硬度方面,TDAP的硬度[(0.037±0.016)N]也比股前外侧[(0.088±0.019)N]、股前内侧[(0.059±0.020)N]和前臂皮瓣[(0.062±0.016)N]小,差异有统计学意义(F值分别为93.27、25.71和29.11,P值均<0.001)。随访2~14个月,38例进行TDAP皮瓣治疗的患者受区功能恢复良好,术后供区瘢痕隐蔽且无严重并发症。结论TDAP皮瓣由于其质地柔软,供区瘢痕隐蔽,且供区功能损失小等优点适合用于头颈部软组织缺损的修复。Objective To analyse the clinical application of thoracodorsal artery perforator flaps(TDAPF)in the repair of head and neck defects.Methods A retrospective review was conducted on 38 patients with oral and maxillofacial head and neck malignant tumors who underwent radical resection of oral and oropharyngeal carcinoma and TDAPF repair in the Department of Oral and Maxillofacial Head and Neck Oncology of the Ninth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2017 to November 2018.Among them,32 were males and 6 were females,aged 30-74 years.Flap size,vessel pedicle length,diameter and number of perforators,and flap fat thickness were recorded and counted.Elasti Meter and Skin Fibro Meter were applied to measure the skin elasticity and hardness in the donor areas of 4 kinds of skin flaps before the flap preparation.SPSS 19.0 statistical software was used for statistical analysis of the data.Results All the flaps survived(100%).The mean elasticity of TDAPF[(41.2±12.9)N/m]was significantly lower than that of anterolateral thigh[(77.6±23.3)N/m,χ^(2)=88.89,P<0.05],anterolateral thigh[(62.6±17.7)N/m,χ^(2)=59.99,P<0.05]and or forearm flap[(51.7±8.6)N/m,χ^(2)=37.82,P<0.05].The hardness of TDAPF[(0.037±0.016)N]was also significantly lower than that of anterolateral femoral[(0.088±0.019)N,F=93.27,P<0.05],anteromedial femoral[(0.059±0.020)N,F=25.71,P<0.05]or forearm flap[(0.062±0.016)N,F=29.11,P<0.05].Follow-up period ranged from 2 to 14 months.The 38 patients treated with TDAPF had a good recovery of the functions in the recipient areas,and the scars of the donor areas were not obvious after surgery,without serious complications.Conclusion TDAPF is suitable for reconstruction of head and neck defect,with ductile texture and good recovery of the morphology and function of head and neck.

关 键 词：外科皮瓣 胸背动脉穿支皮瓣 修复外科手术 硬度 弹性 

分 类 号：R739.41[医药卫生—肿瘤]