三种不同皮瓣在口腔颌面部缺损重建中的应用效果比较  

Comparison of the application effects of three different skin flaps in the reconstruction of oral and maxillofacial defects

作　　者：葛苏蒙 刘喆 刘敏[1] 洪小伟[2] GE Su-meng;LIU Zhe;LIU Min;HONG Xiao-wei(Department of Oral and Maxillofacial Surgery,Stomatological Hospital,Medical School of Nanjing University,Nanjing 210008;Department of Oral and Maxillofacial Head and Neck Tumor Surgery,Nanjing Stomatological Hospital,Nanjing 210000,Jiangsu,China)

机构地区：[1]南京大学医学院附属口腔医院口腔颌面外科,江苏南京210008 [2]南京市口腔医院口腔颌面头颈肿瘤外科,江苏南京210000

出　　处：《川北医学院学报》2024年第3期320-323,共4页Journal of North Sichuan Medical College

基　　金：江苏省自然科学基金青年项目(BK20210033)。

摘　　要：目的:比较前臂游离皮瓣(FRFF)、腹壁下动脉穿支皮瓣(DIEP)、股前外侧皮瓣(ALTF)在口腔颌面部缺损重建中的应用效果。方法:根据口腔颌面部缺损重建皮瓣不同将90例口腔颌恶性肿瘤患者分为FRFF组、DIEP组、ALTF组,每组各30例。比较各组患者手术效果、生活质量及并发症发生情况。结果:各组患者均一期手术成功,手术成功率均为100%,无皮瓣坏死情况。各组患者手术时间、术后首次经口进食时间及住院时间差异均无统计学意义(P>0.05)。术后3个月,各组患者华盛顿大学生存质量调查表(UW-QOL)中娱乐、吞咽、咀嚼、唾液分泌、语言、肩部功能、味觉评分比较差异均无统计学意义(P>0.05)。各组患者UW-QOL量表中疼痛、行动、外貌、情绪、焦虑评分比较差异有统计学意义(P<0.05),其中疼痛、情绪、焦虑评分比较:ALTF组>DIEP组>FRFF组(P<0.05);行动、外貌评分比较:DIEP组、ALTF组均高于FRFF组(P<0.05)。各组患者并发症总发生率有统计学差异(P<0.05),其中ALTF组低于FRFF组(P<0.05)。结论:FRFF、DIEP、ALTF三种皮瓣用于口腔颌面部缺损重建均有较好的修复效果,其中DIEP、ALTF美观度更高、疼痛程度较轻,且ALTF有较高的安全性。Objective:To compare the application effects of free radial forearm flap(FRFF),deep inferior epigastric artery perforator flap(DIEP),and anterolateral thigh flap(ALTF)in the reconstruction of oral and maxillofacial defects.Methods:A total of 90 patients with oral and maxillofacial malignant tumors who underwent reconstruction of oral and maxillofacial defects were selected as the study subjects.According to the treatment methods,they were divided into FRFF group,DIEP group,and ALTF group,with 30 cases in each group.The surgical outcomes,quality of life,and incidence of complication were compared among the three groups of patients.Results:All three groups of patients underwent surgery successfully in the first stage,with a success rate of 100%and no skin flap necrosis.There was no statistically significant difference in the surgical time,first postoperative oral feeding time,and hospital stay among the three groups of patients(P>0.05).3 months after surgery,there was no statistically significant difference in entertainment,swallowing,chewing,saliva secretion,language,shoulder function,and taste scores among the three groups of patients in the Washington university student inventory questionnaire(UW-QOL)(P>0.05).The comparison of pain,action,appearance,emotion,and anxiety scores on the UW-QOL scale among three groups of patients showed statistically significant differences(P<0.05).Among them,the scores of pain,emotion,and anxiety were higher in the DIEP group and ALTF group than those in the FRFF group(P<0.05),and higher in the ALTF group than in the DIEP group(P<0.05).Compared with the FRFF group,the DIEP group and ALTF group had higher scores in terms of action and appearance(P<0.05).There was a statistically significant difference in the total incidence of complications among the three groups of patients(P<0.05),with the ALTF group was lower than the FRFF group(P<0.05).Conclusion:The three types of skin flaps,FRF F,DIEP,and ALTF,have good repair effects for the reconstruction of oral and maxillofacial defects.Am

关 键 词：颌面缺损 口腔颌恶性肿瘤 前臂游离皮瓣 腹壁下动脉穿支皮瓣 股前外侧皮瓣 修复 

分 类 号：R782.2[医药卫生—口腔医学] R739.8[医药卫生—临床医学]