上臂外侧皮瓣在口腔癌术后缺损修复中的应用  

Application of lateral upper arm free flap in the repair of postoperative defects of oral cancer

作　　者：钟外生 许孜 崔捷 陈杰 黄文孝 谭浩蕾 张海林 谭平清 谢李 Zhong Waisheng;Xu Zi;Cui Jie;Chen Jie;Huang Wenxiao;Tan Haolei;Zhang Hailin;Tan Pingqing;Xie Li(Department of Head and Neck Surgery,Hunan Cancer Hospital,The Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410013,China;Department of Head and Neck Radiation Oncology,Hunan Cancer Hospital,The Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410013,China;Department of Head and Neck Surgery,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital,Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518116,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,长沙410013 [2]湖南省肿瘤医院,中南大学湘雅医学院附属肿瘤医院头颈放疗科,长沙410013 [3]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院深圳医院头颈外科,深圳518116

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第10期1219-1224,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：湖南省卫生计生委科研计划课题(B2016054,B2019202,B2019095)。

摘　　要：目的探讨游离上臂外侧皮瓣修复口腔癌术后缺损的临床应用及效果。方法回顾性分析2019年6月至2021年6月湖南省肿瘤医院应用游离上臂外侧皮瓣修复口腔癌术后缺损的46例临床资料,其中男性40例,女性6例,年龄23~64岁。总结皮瓣大小、血管蒂的长度、血管直径、穿支数量、皮瓣存活率、供区并发症以及患者术后住院时间及疗效。采用SPSS 23.0软件进行统计学分析。结果46例患者中,皮瓣大小5.0 cm×3.5 cm~15.0 cm×7.0 cm,血管蒂长度(8.15±1.42)cm,动脉直径(1.20±0.41)mm,静脉直径(2.15±0.52)mm,穿支数量1~4支(平均2.6支),供区切口均一期拉拢缝合。2例患者术后出现皮瓣动脉吻合口血栓,予以清除血栓重新吻合血管后,皮瓣抢救成功。3例皮瓣坏死,皮瓣成活率为93.5%(43/46)。46例患者均未行气管切开。患者术后平均住院时间为9.4 d。随访时间6~24个月,患者术侧肘关节及腕关节活动正常,上肢肌力无影响。结论上臂外侧皮瓣制备简单、切口隐蔽、皮瓣成活率较高,是修复口腔癌术后中小型软组织缺损的一种良好选择。Objective To explore the clinical application and efficacy of lateral upper arm free flap(LUAFF)for one-stage repairing of soft tissue defect after oral cancer surgery.Methods This article was a retrospective analysis of clinical data of 46 patients receiving treatment of one-stage repairing of soft tissue defect with LUAFF after oral cancer surgery in Hunan Cancer Hospital,from June 2019 to June 2021.Among these cases,40 were males,and 6 were females.The patients′ages were from 23 to 64 years old.The clinical data of patients were reviewed and outcomes were evaluated.SPSS 23.0 software was used for statistical analysis.Results In the LUAFF of 46 patients,flap area ranged from 5.0 cm×3.5 cm to 15.0 cm×7.0 cm;the mean pedicle length was 8.15±1.42 cm;the mean artery diameter was 1.20±0.41 mm(range,1.5 to 2.5 mm);the mean diameter of the largest veins was 2.15±0.52 mm;and the median number of perforators was 2.6(range,1 to 4).All donor sites were closed primarily.Two cases had arterial anastomosis thrombosis,but their flaps were successfully saved with urgent re-anastomosis of the vessels.The overall flap survival rate was 93.5%(43/46),with flap necroses after operation in three cases.No patient received tracheotomy.The average hospital stay time of patients after operation was 9.4 days.The follow-up time was 6-24 months,elbow and wrist movements on the operative side were normal,and the upper limb muscle strength was not affected.Conclusions LUAFF is a suitable choice for the repairs of small-moderate tissue defects in oral cancer surgery,with consistent perforators in the flap,simple harvest method,concealed donor-site scar,and high survival rate.

关 键 词：修复外科手术 口腔癌 外科皮瓣 上臂外侧皮瓣 

分 类 号：R739.8[医药卫生—肿瘤]