62例侧颅底肿瘤根治术后缺损重建方法分析  

Analysis and Summary:Reconstructive Methods of Lateral Skull Base Defects after Radical Tumor Resection in 62 Cases

作　　者：朱智慧 侯樱子 赵瑞琪 吴立萌 雷争辉 冯国栋 高志强[3] 张韬[1] ZHU Zhihui;HOU Yingzi;ZHAO Ruiqi;WU Limeng;LEI Zhenghui;FENG Guodong;GAO Zhiqiang;ZHANG Tao(Department of Stomatology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Stomatology,Beijing Zhongguancun Hospital,Beijing 100083,China;Department of Otorhinolaryngology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院口腔科,北京100730 [2]北京市中关村医院口腔科,北京100083 [3]中国医学科学院,北京协和医学院,北京协和医院耳鼻咽喉科,北京100730

出　　处：《协和医学杂志》2021年第6期922-932,共11页Medical Journal of Peking Union Medical College Hospital

基　　金：首都卫生发展科研专项(2020⁃2Z⁃40116);北京市自然科学基金⁃海淀原始创新联合基金(L182066);国家重大疾病多学科合作诊疗能力建设项目。

摘　　要：目的对侧颅底肿瘤根治术后不同修复重建方法进行分析、总结。方法本研究为回顾性分析。研究对象为2012年1月1日至2019年12月31日北京协和医院口腔科和耳鼻咽喉科行侧颅底肿瘤根治术及修复重建的患者。依据缺损情况(不伴皮肤缺损、伴皮肤缺损、伴下颌骨体部及升支缺损)进行不同方法的修复重建,并观察患者出院时伤口愈合情况及重建效果。结果共62例患者(63次缺损修复术)纳入本研究。其中不伴皮肤缺损34例、伴皮肤缺损23例、伴下颌骨体部及升支缺损5例,组织瓣成活率为98.41%(62/63),伤口一期愈合率为90.48%(57/63)。不伴皮肤缺损患者中,采取游离脂肪填充修复6例、颞肌瓣联合游离脂肪填充修复14例、胸锁乳突肌瓣或联合颞肌瓣修复13例、颞肌瓣联合颌下腺瓣修复1例;其中2例术后出现脑脊液漏,换药后延期愈合;34例患者术后均未发生感染与脂肪液化,组织瓣成活率为100%,伤口一期愈合率为94.12%(32/34)。伴皮肤缺损患者中,缺损直径≤3 cm者5例,均采用颈面部推进皮瓣联合颞肌瓣和/或胸锁乳突肌瓣修复,皮瓣成活率为100%,伤口一期愈合率为100%;缺损直径>3 cm者18例(19次缺损修复术),其中行股前外侧肌皮瓣修复8例、胸大肌等带蒂皮瓣修复6例、前臂皮瓣联合带蒂皮瓣或局部组织瓣修复2例、胸大肌皮瓣或联合颈面部推进皮瓣及颌下腺瓣修复2例、腹直肌皮瓣修复1例,1例曾行大剂量放疗患者采用股前外侧肌皮瓣修复后3 d出现静脉栓塞,后改用胸大肌皮瓣救援修复后一期愈合;1例采用股前外侧肌皮瓣移植患者术后第2天出现血肿,清除血肿后伤口一期愈合;1例腹直肌皮瓣修复患者术后出现脑脊液漏,换药后皮损延期愈合;2例采用胸大肌等带蒂皮瓣修复后出现远端小面积坏死,经换药后伤口延期愈合;余患者的伤口均一期愈合,一期愈合率为84.21%(16/19),皮瓣成活率为94.74%(1Objective To explore the methods for the reconstruction of lateral skull base defects after radical tumor resection.Methods Patients who underwent lateral skull base radical tumor resection and recon⁃struction from January 1,2012 to December 31,2019 in the Department of Stomatology and Otorhinolaryngology in Peking Union Medical College Hospital,were enrolled in this retrospective study.These patients were divided into three subgroups depending on the type of defects.Group I,patients without skin defects;GroupⅡ,patients with skin defects;GroupⅢ,patients with larger jaw defects.Different reconstructive methods were applied for the three groups.Results Sixty⁃two patients(63 procedures of defect repair)were enrolled in this study.The surviv⁃al rate of tissue flap was 98.41%(62/63),and the primary wound healing rate was 90.48%(57/63).There were 34 patients in Group I.Among them,6 cases received free fat transplantation;14 cases were repaired with fat transplantation combined with local flaps;13 cases were repaired with sternocleidomastoid muscle flap or com⁃bined temporal muscle flap;1 case was repaired with temporal muscle flap combined with submandibular gland flap.Among them,two patients had postoperative cerebrospinal fluid leakage and delayed healing after dressing change.All patients had no postoperative infection and fat liquefaction,and the wounds healed by primary inten⁃tion.The survival rate of tissue flap was 100%,and 94.12%(32/34)of the wounds healed by primary intention.There were 23 patients in GroupⅡ.Five patients whose skin defects were less than 3 cm were reconstructed with local tissue flaps combined with advancement flaps;all flaps survived completely and the wounds healed by pri⁃mary intention.The survival rate of tissue flap was 100%,and the primary wound healing rate was 100%.For those skin defects greater than 3 cm,free anterolateral thigh flaps were applied in 8 patients,pedicle flaps such as pectoralis flaps in 6 patients,2 cases used forearm flap combined with pedicle skin

关 键 词：侧颅底肿瘤 缺损 重建方法 局部组织瓣 带蒂皮瓣 游离皮瓣 

分 类 号：R739.81[医药卫生—肿瘤]