三种不同类型组织瓣修复眶区组织缺损的回顾性分析  

Retrospective analysis of three different types of tissue flaps in reconstruction of tissue defects of orbital region

作　　者：吴旭彬 阿不都克力木江·买买提 姚志涛 阿迪力江·赛买提 居来提·吐尔逊 安玮 丁泰然 张思敏 买买提吐逊·吐尔地 Wu Xubin;Abudukelimujiang·Maimaiti;Yao Zhitao;Adilijiang·Saimaiti;Julaiti·Tuerxun;An Wei;Ding Tairan;Zhang Simin;Maimaitituxun·Tuerdi(Department of Oral and Maxillofacial Trauma and Orthognathic Surgery,the First Affiliated Hospital of Xinjiang Medical University(Affiliated Stomatological Hospital),Xinjiang Institute of Stomatology,Department of Basic Dentistry,Xinjiang Medical University School of Oral Stomatology,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院(附属口腔医院)口腔颌面创伤正颌外科,新疆维吾尔自治区口腔医学研究所,新疆医科大学口腔医学院基础教研室,乌鲁木齐830054

出　　处：《中华整形外科杂志》2023年第5期479-489,共11页Chinese Journal of Plastic Surgery

摘　　要：目的探讨3种不同类型组织瓣修复眶区恶性肿瘤扩大切除术后眶内组织缺损的临床效果及适应证。方法回顾性分析2017年1月至2021年12月新疆医科大学第一附属医院(附属口腔医院)口腔颌面创伤正颌外科诊治的眶区恶性肿瘤患者的临床资料。术中行眶周恶性肿瘤扩大切除术及眶内容物剜除术,根据眶周软、硬组织及眶内容物缺损范围及患者情况,应用颞肌筋膜瓣联合全厚皮片(TMF-FTSG组)、带蒂胸大肌肌皮瓣(PMMF组)或游离股前外侧皮瓣(ALTF组)进行修复。术后对患者供、受区创面愈合情况、并发症等进行随访,并比较TMF-FTSG组患者术后3个月和术前张口度,比较3组患者术前和术后1年华盛顿大学生活质量问卷(UW-QOL)评分(共12个项目,每个项目赋值0~100分,分数越高恢复情况越好)。应用SPSS 26.0软件进行统计分析,计量资料以±s表示,组内术前后数据比较采用配对t检验,P<0.05为差异有统计学意义。结果共纳入22例患者,其中TMF-FTSG组8例,男4例,女4例,年龄(68.3±9.7)岁;PMMF组6例,男5例,女1例,年龄(65.8±7.8)岁;ALTF组8例,男3例,女5例,年龄(63.8±5.4)岁。22例中鳞状细胞癌12例,基底细胞癌8例,腺样囊性癌2例。TMF-FTSG组、PMMF组、ALTF组患者肿瘤切除后软组织缺损范围分别为4 cm×4 cm~7 cm×8 cm、4 cm×5 cm~9 cm×9 cm、5 cm×6 cm~14 cm×9 cm,切取组织瓣面积依次为5 cm×4 cm~8 cm×9 cm、5 cm×7 cm~10 cm×10 cm、10 cm×6 cm~20 cm×9 cm。术后20例受区及22例供区均一期愈合,2例受区二期愈合。术后随访(27.2±13.0)个月,PMMF组中有1例患者因肿瘤局部复发,术后13个月死亡;其余患者未见转移及复发情况。TMF-FTSG组术后3个月张口度[(3.60±0.36) cm]与术前[(3.84±0.15)cm]比较,差异无统计学意义(P>0.05)。UW-QOL评分显示,3组患者术后1年外形、情绪、焦虑得分均高于术前(P<0.05),活动、肩膀得分均低于术前(P<0.05);术后1年疼痛和娱乐得分,TMF-FTSG�Objective To investigate the clinical effect of three different tissue flaps in repairing patients with orbital region tissue loss after enlarged resection of malignant tumors in the orbital region,as well as the indication.Methods Retrospective analysis of data of patients with malignant tumors in the orbital region treated in the Department of Oral and Maxillofacial Trauma and Orthognathic Surgery,the First Affiliated Hospital of Xinjiang Medical University(Affiliated Stomatological Hospital)between January 2017 and December 2021.All patients underwent extensive resection of periorbital malignant tumors and enucleation of orbital contents,depending on defects in periorbital soft/hard tissues and orbital contents,temporalis myofascial flap combined with full thickness skin grafts(TMF-FTSG group),modified pectoralis major myocutaneous flap(PMMF group),and free anterolateral thigh flap(ALTF group)were used to repair the tissue defect.The wound healing and complications of the donor and recipient areas were followed up after operation,and degree of mouth opening in the TMF-FTSG group was compared at 3 months after operation and before operation.The University of Washington quality of life scale(UW-QOL)score was compared among the three groups before and 1 year after operation(a total of 12 items,each item was assigned from 0 to 100 points,the higher the score,the better the recovery).Statistical software SPSS 26.0 was used to analyze the data.The measurement data were expressed as Mean±SD,and the paired t-test was used to compare the preoperative and postoperative data within the group,the difference was statistically significant at a P value less than 0.05.Results A total of 22 patients were enrolled.There were 8 patients in TMF-FTSG group,4 males and 4 females,aged(68.3±9.7)years.There were 6 patients in PMMF group,5 males and 1 female,aged(65.8±7.8)years.There were 3 males and 5 females in ALTF group,aged(63.8±5.4)years.There were 12 cases of squamous cell carcinoma,8 cases of basal cell carcinoma and 2 case

关 键 词：眼肿瘤 颞肌筋膜瓣 股前外侧皮瓣 胸大肌肌皮瓣 修复外科手术 

分 类 号：R739.72[医药卫生—肿瘤]