游离腓动脉嵌合穿支皮瓣修复腮腺癌晚期局部病变术后缺损  

Application of free peroneal artery chimeric perforator flap in repairing the defect after advanced local lesions resection in parotid gland carcinoma

作　　者：杨东昆[1] 李建成[1] 吴志刚 胡恺 郭蕴 孙悦 YANG Dongkun;LI Jiancheng;WU Zhigang;HU Kai;GUO Yun;SUN Yue(Department of Stomatology,the First Affiliated Hospital ofBengbu Medical College,Bengbu Anhui,233004,P.R.China)

机构地区：[1]蚌埠医学院第一附属医院口腔颌面外科,安徽蚌埠233004

出　　处：《中国修复重建外科杂志》2022年第1期79-85,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：安徽省教育厅高等学校自然科学研究项目(KJ2019A0374);安徽省教育厅省属本科医学院校公共卫生协同创新项目(GXXT-2020-021)。

摘　　要：目的探讨游离腓动脉嵌合穿支皮瓣修复腮腺癌(parotid gland carcinoma,PGC)晚期局部病变术后缺损的疗效。方法2010年6月—2020年6月,收治32例PGC晚期局部病变患者。扩大根治术后,17例采用游离腓动脉嵌合穿支皮瓣修复缺损(试验组),15例采用带蒂胸大肌肌皮瓣修复缺损(对照组)。两组患者性别、年龄、疾病类型、病理学分型、临床分期及病理分期比较,差异均无统计学意义(P>0.05),具有可比性。术中试验组皮瓣切取范围为7 cm×6 cm~12 cm×8 cm,比目鱼肌肌瓣切取范围为5 cm×3 cm~6 cm×4 cm;供区植皮修复。对照组肌皮瓣切取范围为9 cm×6 cm~14 cm×7 cm;供区减张缝合。记录并比较两组手术时间、皮瓣成活以及患者存活情况,术后1年采用华盛顿大学生存质量量表(UW-QOL)评价患者生存质量,包括外貌、肩部运动、社交、咀嚼、语言、情绪6个方面评分。结果两组手术均顺利完成,其中试验组手术时间(6.19±0.72)h,对照组(6.41±0.71)h,差异无统计学意义(t=–0.863,P=0.395)。试验组术后1例出现血管危象,改用带蒂胸大肌肌皮瓣修复;皮瓣成活率为94.1%(16/17)。对照组皮瓣成活率为100%。两组供区切口均Ⅰ期愈合,植皮均成活。两组患者均获随访,试验组随访时间6~60个月,中位时间60个月;对照组为7~60个月,中位时间60个月。术后1、3、5年试验组患者累积生存率分别为94.1%、64.7%、58.8%,对照组分别为86.7%、66.7%、53.3%,组间差异无统计学意义(χ^(2)=0.090,P=0.762)。术后1年根据UW-QOL量表,试验组在外貌、肩部运动、社交及情绪方面的评分高于对照组,差异有统计学意义(P<0.05);在咀嚼和语言方面评分两组差异无统计学意义(P>0.05)。结论腓动脉穿支血管解剖恒定,每条穿支血管均发出肌支营养比目鱼肌,可根据组织缺损情况设计个性化游离腓动脉嵌合穿支皮瓣,修复PGC晚期局部病变术后缺损。Objective To investigate the effectiveness of free peroneal artery chimeric perforator flap in repairing the defect after advanced local lesions resection in parotid gland carcinoma(PGC).Methods Between June 2010 and June 2020,32 patients with advanced local lesions of PGC were treated with extended radical resection.After that,17 patients were repaired with the free peroneal artery chimeric perforator flaps(trial group)and another 15 patients were repaired with the pedicled pectoralis major myocutaneous flaps(control group).There was no significant difference in gender,age,disease type,histopathological classification,clinical stage,and pathological stage between groups(P>0.05).The size of skin flap in trial group ranged from 7 cm×6 cm to 12 cm×8 cm and the size of soleus muscle flap ranged from5 cm×3 cm to 6 cm×4 cm.The donor sites were repaired with skin grafting.The size of the pedicled pectoralis major myocutaneous flaps in control group ranged from 9 cm×6 cm to 14 cm×7 cm.The donor sites were sutured directly.The operation time,survival rate of flap,and postoperative survival of patients were recorded and compared between groups.At 1 year after operation,the University of Washington quality of life(UW-QOL)questionnaire was used to evaluate the quality of life of patients in the two groups,including appearance,shoulder movement,sociability,masticatory function,speech function,and mood.Results The operations completed successfully.The operation time was(6.19±0.72)hours in trial group and(6.41±0.71)hours in control group,showing no significant difference between groups(t=–0.863,P=0.395).The survival rate of flap in trial group was 94.1%(16/17);and 1 patient suffered from vascular crisis after operation and was replaced with the pedicled pectoralis major myocutaneous flap.The survival rate of flap in control group was 100%.All grafts survived and the incisions healed by first intention in the two groups.All patients were followed up.The follow-up time was 6-60 months(median,60 months)in trial group an

关 键 词：腓动脉 嵌合穿支皮瓣 腮腺癌 局部病变 创面修复 

分 类 号：R739.87[医药卫生—肿瘤]