预扩张颈横动脉颈段皮支皮瓣与传统手术修复儿童颈部大面积缺损的对比研究  

Comparative study of pre-expanded flap containing cervical cutaneous branch of transverse cervical artery versus traditional surgery for large cervical tissue defects in children

作　　者：高庆文[1] 沈卫民[1] 崔杰[1] 季易[1] 孔亮亮 陈建兵[1] Gao Qingwen;Shen Weimin;Cui Jie;Ji Yi;Kong Liangliang;Chen Jianbing(Department of Burn&Plastic Surgery,Affiliated Children's Hospital,Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院烧伤整形外科,南京210008

出　　处：《中华小儿外科杂志》2023年第4期289-294,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的:比较预扩张颈横动脉颈段皮支皮瓣(pre-expanded flaps containing cervical cutaneous branch of transverse cervical artery,PCTA)与传统手术修复儿童颈部大面积缺损的临床效果。方法:回顾性分析2001年1月至2021年1月在南京医科大学附属儿童医院烧伤整形科进行手术治疗的颈部大面积缺损的98例患儿临床资料。依据手术方式分为传统手术组(76例)和PCTA组(22例)。传统手术组中,男42例,女34例;手术年龄为(71.54±33.40)个月,年龄范围在2.00~173.00个月;缺损面积为(66.11±40.6)cm^(2);缺损原因为瘢痕64例、血管瘤2例、皮脂腺痣2例、黑痣8例。PCTA组中,男14例,女8例;手术年龄为(70.90±45.50)个月,年龄范围在20.00~212.00个月;缺损面积为(90.73±31.57)cm^(2);致缺损原因为瘢痕18例、皮脂腺痣1例、黑痣3例。比较两组患儿术后并发症、再次手术率及患儿家属满意度。两组间计量资料比较采用t检验,多组间计量资料比较采用方差分析,组间计数资料比较采用卡方检验。结果:传统手术组与PCTA组分别埋置86、36个扩张器,传统手术组扩张器相关并发症发生率为32.6%(28/86),相较于PCTA组的11.1%(4/36)更高(χ^(2)=6.00,P=0.014)。在术后皮瓣并发症发生率上,传统手术组(46.1%,35/76)比PCTA组(18.2%,4/22)更高(χ^(2)=5.53,P=0.019)。传统手术组的再次手术率为40.8%(31/76),相较于PCTA组的9.1%(2/22)更高(χ^(2)=7.68,P=0.006)。传统手术组患儿家长满意度(2.526±0.945)明显低于PCTA组(4.227±0.813)(t=-7.66,P<0.001)。结论:PCTA是修复儿童颈部大面积皮肤缺损的一种较好选择,能够在降低术后并发症、再次手术率及增加患儿家属满意度上明显优于传统手术方式。Objective To explore the clinical outcomes of pre-expanded flap containing cervical cutaneous branch of transverse cervical artery(PCTA)versus traditional surgery for pediatric large cervical tissue defects.Methods From January 2001 to January 2021,retrospective review was conducted for 98 children operated for large cervical defects.According to operative modus,they were assigned into two groups of traditional operation(n=76)and PCTA(n=22).In traditional operation group,there were 42 boys and 34 girls with a mean operative age of(71.54±33.40)(2.00-173.00)months and a defect area of(66.11±40.6)cm^(2).The underlying causes were scar(n=64),hemangioma(n=2),sebaceous nevus(n=2)and nevus(n=8).In PCTA group,there were 14 boys and 8 girls with a mean operative age of(70.90±45.50)(20.00-212.00)months and a defect area of(90.73±31.57)cm^(2).The underlying causes were scar(n=18),sebaceous nevus(n=1)and nevus(n=3).Postoperative complications,reoperative rate and parental satisfaction were compared between two groups.The inter-group data were compared by t-test,the measurement data between multiple groups by analysis of variance and the enumeration data between groups by Chi-square test.Results Eighty-six and 36 expanders were implanted in traditional operation and PCTA groups respectively.The incidence of expander-related complications was higher in traditional operation group than that in PCTA group[32.6%(28/86)vs 11.1%(4/36),χ^(2)=6.003,P=0.014].The incidence of postoperative flap complications in traditional operation group was higher than that in PCTA group[(46.1%,35/76)vs(18.2%,4/22),χ^(2)=5.532,P=0.019].The reoperative rate was higher in traditional operation group than that in PCTA group[(40.8%,31/76)vs(9.1%,2/22),χ^(2)=7.676,P=0.006].Parental satisfaction was significantly lower in traditional operation group than that in PCTA group[(2.526±0.945)vs(4.227±0.813),t=-7.658,P<0.001].Conclusions PCTA is a preferable option for repairing large cervical tissue defects of children.It is superior to traditional moda

关 键 词：外科皮瓣 颈横动脉 修复外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]