薄型股前外侧皮瓣修复舌体缺损对患者语音功能的影响及皮瓣坏死危险因素分析  

Effect of thinned anterolateral thigh flap in the repair of tongue defects on speech function and analysis of risk factors of flap necrosis

作　　者：周湘[1,2] 杜宁 刘昕[2] ZHOU Xiang;DU Ning;LIU Xin(Department of Full Office,Children's Hospital of Hebei Province,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院全质办,河北石家庄050031 [2]河北省肿瘤医院口腔科,河北石家庄050011

出　　处：《中国美容整形外科杂志》2022年第3期147-150,共4页Chinese Journal of Aesthetic and Plastic Surgery

基　　金：河北省医学科学研究重点课题(20190131)。

摘　　要：目的探究薄型股前外侧皮瓣修复舌体缺损对患者语音功能的影响,并分析皮瓣坏死危险因素。方法自2018年1月至2020年6月,河北省肿瘤医院收治的46例舌癌根除术患者,采用薄型股前外侧皮瓣修复,观察患者术后舌肌运动评分、舌尖音、舌根音及边音语音清晰度;并统计修复术后患者皮瓣成活情况,分析皮瓣坏死的危险因素。结果本组共46例患者,皮瓣成活41例(89.13%),皮瓣全部坏死5例(10.87%)。术后随访6个月,舌体修复处瘢痕较小,受区功能恢复较好,术后舌肌运动、语音功能均恢复较好,且舌肌运动评分、舌尖音PI、舌根音PI、边音PI值术后2个月<4个月<6个月,差异均具有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄>60岁、高血压、糖尿病、吸烟史、血管蒂过长、皮瓣受区感染、NRS疼痛评分>7分为皮瓣坏死影响因素(OR=0.049、10.909、0.137、18.772、16.479、19.263、0.075,P<0.05)。结论薄型股前外侧皮瓣修复术对舌体缺损患者术后舌体重建效果显著,其可有效恢复患者舌运动,改善舌癌患者术后的语音功能。年龄>60岁、高血压、糖尿病、吸烟史、血管蒂过长、皮瓣受区感染、NRS疼痛评分>7分为皮瓣坏死危险因素。Objective To explore the effect of thinned anterolateral thigh flap in the repair of tongue defects on speech function and analysis of risk factors of flap necrosis.Methods From January 2018 to June 2020,46 patients underwent radical surgery of tongue cancer were selected as the subjects.All patients were repaired by thinned anterolateral thigh flap.The scores of tongue muscle activity and speech intelligibility were observed after operation.The flap survival was counted and the risk factors of flap necrosis were analyzed.Results A total of 46 patients involved in this study,there were 41 cases of flap survival(89.13%)and 5 cases of total flap necrosis(10.87%).All patients were followed-up for 6 months,the scar of tongue after repair was not obvious and the function recovery of recipient site was good.The recovery of tongue muscle activity and speech function was good after operation.The scores of tongue muscle activity and PI of speech intelligibility at 2 months after operation were less than 4 months less than 6 months.The differences were statistically significant(P<0.05).A multivariate logistic regression analysis showed that the age more than 60 years old,hypertension,diabetes mellitus,smoking,vascular pedicle too long,infection of recipient site and NRS pain scores more than 7 were the influencing factors of flap necrosis(OR=0.049,10.909,0.137,18.772,16.479,19.263,0.075,P<0.05).Conclusion The efficacy of thinned anterolateral thigh flap in the repair of tongue defects is remarkable.This method could effectively restore tongue activity and improve speech function in patients with tongue cancer after operation.The age more than 60 years old,hypertension,diabetes mellitus,smoking,vascular pedicle too long,infection of recipient site and NRS pain scores more than 7 are the risk factors of flap necrosis.

关 键 词：舌癌根治术 舌体缺损 薄型股前外侧皮瓣修复术 语音功能 皮瓣坏死 

分 类 号：R739.86[医药卫生—肿瘤]