超声刀在辅助制备游离腓骨肌皮瓣中的临床应用  

Clinical application of ultrasonic scalpel in the preparation of fibular osteomyocutaneous free flap

作　　者：胡潇丹 徐豪越 李晓[1,2] 卜令学[1,2] 贾暮云[1,2] 袁荣涛 庞宝兴[1,2] HU Xiaodan;XU Hao-yue;LI Xiao;BU Ling-xue;JIA Mu-yun;YUAN Rong-tao;PANG Bao-xing(Department of Oral and Maxillofacial Surgery,Affiliated Hospital of Qingdao University,Qingdao University,Qingdao 266003;School of Stomatology of Qingdao University,Qingdao 288003;Qingdao Municipal Hospital,Affiliated to Shandong University,Qingdao 266071,Shandong Province,China)

机构地区：[1]青岛大学附属医院口腔颌面外科,山东青岛266003 [2]青岛大学口腔医学院,山东青岛266003 [3]青岛市市立医院口腔医学中心,山东青岛266071

出　　处：《中国口腔颌面外科杂志》2023年第2期152-157,共6页China Journal of Oral and Maxillofacial Surgery

基　　金：山东省自然科学基金(ZR2017BH034)。

摘　　要：目的:探讨超声刀在辅助制备游离腓骨肌皮瓣中的可行性和实用性。方法:收集2019年9月—2022年3月就诊于青岛大学附属医院口腔颌面外科需行游离腓骨肌皮瓣修复头颈部缺损的患者62例。其中,实验组采用超声刀辅助制备游离腓骨肌皮瓣(n=30),对照组采用传统单极电刀制备游离腓骨肌皮瓣(n=32)。比较2组患者的腓骨肌皮瓣制备时间、术中总失血量、腓骨供区失血量、腓骨供区引流量、腓骨供区引流天数等手术相关指标,以及术后引流液中肿瘤坏死因子(TNF-α)、白细胞介素6(IL-6)水平,术后并发症(出血、水肿、皮瓣坏死)和术后腓骨供区的疼痛评分。采用SPSS 25.0软件包对数据进行统计学分析。结果:实验组腓骨供区失血量显著降低(P<0.01),腓骨肌皮瓣制备时间、术中总失血量、腓骨供区引流量、腓骨供区引流天数显著减少(P<0.05)。实验组术后引流液中TNF-α及IL-6水平显著下降(P<0.01)。2组术后并发症无统计学差异(P>0.05)。2组患者腓骨供区术后第1天疼痛评分无显著差异(P>0.05),但实验组腓骨供区术后2~5天的疼痛评分显著降低(P<0.05)。结论:超声刀辅助制备游离腓骨肌皮瓣较传统单极电刀损伤更小,患者术后恢复更好,术中采用超声刀止血在口腔修复重建外科中具有良好的临床应用前景。PURPOSE:To explore the feasibility and practicability of ultrasonic scalpel in the preparation of fibular os-teomyocutaneous free flap.METHODS:From September 2019 to March 2022,62 patients who needed fibular osteomy-ocutaneous free flap to repair head and neck defects in the Department of Oral and Maxillofacial Surgery,Affiliated Hos-pital of Qingdao University were collected.In the experimental group,fibular osteomyocutaneous free flaps were prepared by ultrasonic scalpel(n=30);while in the control group,fibular osteomyocutaneous free flaps were prepared by traditional monopolar electrotome(n=32).The preparation time of fibular osteomyocutaneous free flap,total intraoperative blood loss,blood loss of fibular donor site,drainage volume of fibular donor site,drainage days of fibular donor site and other surgery-related indexes were compared.The levels of tumor necrosis factor(TNF-α)and interleukin-6(IL-6)in the post-operative drainage fluid were also compared.At the same time,postoperative complications(bleeding,edema,flap necro-sis)and postoperative fibula donor site pain score were compared.SPSS 25.0 software package was used for statistical analysis.RESULTS:In the experimental group,the blood loss from fibular donor site was significantly decreased(P<0.01),and the preparation time of fibular osteomyocutaneous free flap,the total intraoperative blood loss,the drainage volume of fibular donor site,and the drainage days of fibular donor site were significantly decreased(P<0.05).The levels of TNF-αand IL-6 in the drainage fluid of the experimental group were significantly decreased(P<0.01).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).In addition,there was no significant difference in the pain score of the fibular donor site on the first day after operation between the two groups(P>0.05),but the pain score of the fibular donor site in the experimental group was significantly decreased from the second day to the fth day after operation(P<0.05).CO

关 键 词：超声刀 游离腓骨肌皮瓣 修复重建 

分 类 号：R782.2[医药卫生—口腔医学]