应用血管化游离组织瓣修复头颈部肿瘤缺损时血管危象的临床分析  

Clinical Analysis of Vascular Crisis Management When Using Vascularized Free Tissue Flap to Repair Head and Neck Tumor Defects

作　　者：单振锋 周晓 喻建军 蔡旭 SHAN Zhenfeng;ZHOU Xiao;YU Jianjun;CAI Xu(Head and Neck Surgery Department,Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410013,China)

机构地区：[1]湖南省肿瘤医院/中南大学湘雅医学院附属肿瘤医院头颈外科,湖南长沙410013

出　　处：《河南医学研究》2022年第8期1351-1354,共4页Henan Medical Research

基　　金：湖南省自然科学基金(2019JJ40216)。

摘　　要：目的总结应用血管化游离组织瓣修复头颈部肿瘤缺损时处理血管危象的经验和教训。方法收集湖南省肿瘤医院2011年1月1日至2021年1月1日同一手术组医生共同完成的539例应用血管化游离组织瓣移植修复头颈部缺损患者的临床资料,总结移植血管危象的征象及其处理方法。结果血管化游离股前外侧皮瓣516例,成活511例,失败5例;游离腓骨组织瓣23例,成活22例,失败1例;术后出现血管危象23例,进行二次手术探查21例,2例保守治疗,抢救成功17例,2例直接切除皮瓣行胸大肌皮瓣修复,1例取出移植骨。结论熟练掌握血管吻合技术是预防血管危象的关键,术中选择合适的血管、止血彻底、术后6h内密切观察皮瓣、及早发现血管危象是保证游离皮瓣成活的关键。Objective To summarize the experience and lessons of treating vascular crisis when repairing head and neck tumor defect with vascularized free tissue flap.Methods The clinical data of 539 patients with head and neck defects repaired by vascularized free tissue flap transplantation were collected from January 1,2011 to January 1,2021 in Hunan Cancer Hospital.The signs and treatment methods of transplanted vascular crisis were summarized.Results Five hundred and sixteen cases of free anterolateral femoral flap were vascularized,511 survived and 5 failed.Free fibular flap in 23 cases,22 cases survived,1 case failed.There were 23 cases of vascular crisis after operation,21 cases underwent secondary surgical exploration,2 cases were treated conservatively,17 cases were rescued successfully,2 cases underwent direct resection of the flap for pectorals major myocutaneous flap repair,and 1 case took out the bone graft.Conclusion Mastering the familiar vascular anastomosis technolog is the key to preventing vascular crisis.In choosing the appropriate blood vessel,bleeding completely,postoperative close observation flap within 6 hours after operation,early detection of vascular crisis is the key to ensure the survival of free flap.

关 键 词：血管危象 皮瓣 头颈部肿瘤 显微外科 

分 类 号：R739.91[医药卫生—肿瘤]