上颌骨切除术后缺损分型及一期精准修复的研究  

A new classification of maxillary defect and simultaneous accurate reconstruction

作　　者：房居高[1] 李云霞[1] 张罗[1] 钟琦[1] 侯丽珍[1] 马泓智[1] 何时知 冯凌[1] 王茹[1] 陈晓红[1] 黄志刚[1] Fang Jugao;Li Yunxia;Zhang Luo;Zhong Qi;Hou Lizhen;Ma Hongzhi;He Shizhi;Feng Ling;Wang Ru;Chen Xiaohong;Huang Zhigang(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第1期8-14,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的对上颌骨肿瘤术后的缺损进行分型,以便精准的筛选各型缺损修复的合适组织瓣。方法回顾性分析2005年1月至2018年12月首都医科大学附属北京同仁医院经治的组织瓣一期修复重建上颌骨缺损的患者219例,其中男性136例,女性83例,年龄16~78岁。依据修复方式的选择,将上颌骨缺损分为4型,其中上颌骨下部缺损(Ⅰ型)22例,上颌骨上部缺损(Ⅱ型)44例,全上颌骨缺损(Ⅲ型)132例,扩大上颌骨缺损(Ⅳ型)21例。对皮瓣成活以及修复重建满1年的患者进行外观和功能的评价,并对恶性肿瘤患者(169例)进行生存分析。采用Kaplan-Meier法计算生存率,Log-rank法比较各组生存率差异。结果本组219例患者共行234个皮瓣修复手术,Ⅰ型缺损修复采用腓骨瓣频率最高(4/13)。Ⅱ型缺损采用颞肌瓣(11/24,45.8%)及股前外侧皮瓣(6/24,25.0%)频率较高,Ⅲ型缺损采用颞肌瓣(71/128,55.5%)、股前外侧皮瓣(32/128,25.0%)及腓骨瓣(12/128,9.4%)频率较高,Ⅳ型缺损采用股前外侧皮瓣(8/20,40.0%)及腹直肌皮瓣(8/20,40.0%)频率较高。局部带蒂皮瓣114例,成活率95.6%(109/114);游离皮瓣120例,成活率95.8%(115/120)。皮瓣吻合血管血栓发生率为4.3%(10/234),是组织瓣修复重建失败的主要原因。88例患者完成术后1年的生活质量随访,均恢复了正常的吞咽及语言功能,其中82例(93.2%)对外形较满意,75例(85.2%)对于视力视野较满意。恶性肿瘤患者3年及5年总体生存率为66.5%和63.6%,3年及5年的无病生存率为57.1%和46.2%。结论根据上颌骨缺损各分型的特点选择适合的组织瓣,兼顾了功能和外形,在不影响生存率的前提下,可以提高患者术后生活质量。Objective To select the preferred flaps for the reconstruction of different maxillary defects and to propose a new classification of maxillary defects.Methods A total of 219 patients(136 males and 83 females)underwent the simultaneous reconstruction of maxillary defects in the Beijing Tongren Hospital,Capital Medical University,between January 2005 and December 2018 were reviewed.Age ranged from 16 to 78 years.Based on the proposed new classification of the maxillary defects,22 patients with classⅠdefects(inferior maxillectomy),44 patients with classⅡdefects(supperior maxillectomy),132 patients with classⅢdefects(total maxillectomy)and 21 patients with classⅣdefects(extensive maxillectomy)were enrolled.Survival rate,functional and aesthetic outcomes of flaps were evaluated.Survival analysis was performed in 169 patients with malignant tumor,Kaplan-Meier method was used to calculate the survival rate,and Log-rank method was used to compare the difference of survival rate in each group.Results A total of 234 repairs for maxillary defects were performed in 219 patients.Fibula flaps were used in 4/13 of classⅠdefects;temporal muscle flaps(11/24,45.8%)and anterolateral thigh flaps(6/24,25.0%)used in classⅡdefects;temporal muscle flaps(71/128,55.5%),anterolateral thigh flaps(6/24,25.0%)and fibula flaps(12/128,9.4%)used in classⅢdefects;and anterolateral thigh flaps(8/20,40.0%)and rectus abdominis flaps(8/20,40.0%)used in classⅣdefects.The success rate of local pedicled flaps was 95.6%(109/114)and that of free flaps was 95.8%(115/120).Thrombosis(10/234,4.3%)was a main reason for repair failure.Among the followed-up 88 patients,swallowing and speech functions recovered,82(93.2%)of them were satisfied with appearance,and 75(85.2%)were satisfied with visual field.The 3-year and 5-year overall survival rates were 66.5%and 63.6%,and the 3-year and 5-year disease-free survival rates were 57.1%and 46.2%,respectively,in the 169 patients with malignant tumors.Conclusion A new classification of maxillary defects i

关 键 词：上颌骨缺损 外科皮瓣 修复外科手术 分型 

分 类 号：R739.82[医药卫生—肿瘤]