股前外侧游离皮瓣修复舌癌术后缺损疗效分析  

Application of Free Flap Repair and Tongue Reconstruction in Patients with Tongue Carcinoma Resection

作　　者：朱威[1] 张伟[1] 代林林[1] 曲学华[1] ZHU Wei;ZHANG Wei;DAI Linlin;QU Xuehua(Department of Otolaryngology,Oral and Maxillofacial Surgery,the Fourth Affi liated Hospital of Harbin Medical University,Harbin 150000,Heilongjiang,China)

机构地区：[1]哈尔滨医科大学附属第四医院耳鼻喉口腔颌面外科,黑龙江哈尔滨150000

出　　处：《中国美容医学》2024年第6期106-111,共6页Chinese Journal of Aesthetic Medicine

摘　　要：目的:探讨舌癌切除后患者采用游离皮瓣修复再造术对运动功能和语言功能的影响。方法:选取笔者医院2020年1月-2022年5月收治的86例舌癌切除后患者。根据患者术后创面情况采用不同的术式修复缺损,外周血管条件差、缺损组织量较大的患者采用胸大肌皮瓣修复。具备良好的外周血管状态,缺损组织量相对较小,且皮瓣可以覆盖的区域与患者舌部切除后的缺损相匹配,则选择股前外侧肌皮瓣修复。按照皮瓣修复方法分为股前外侧肌皮瓣组(43例)和胸大肌皮瓣组(43例)。结果:两组患者皮瓣受区及周围均未出现炎症,舌体形状正常,全部成活,移植皮瓣颜色、质地、弹性、皮温良好。股前外侧肌皮瓣组术后恢复时间显著短于胸大肌皮瓣组(P<0.05)。与术前相比,两组患者术后2个月、4个月、6个月舌肌运动评分提高(P<0.05),且股前外侧肌皮瓣组舌肌运分显著高于胸大肌皮瓣组(P<0.05)。术后6个月舌根音语音清晰度(Phonetic intelligibity,PI)值、舌尖音PI值、边音PI值较同组术前均显著提高(P<0.05),且股前外侧肌皮瓣组MTF评分显著高于胸大肌皮瓣组(P<0.05)。股前外侧肌皮瓣组并发症发生率(4.65%)显著低于胸大肌皮瓣组(20.93%),差异具有统计学意义(P<0.05)。结论:舌癌切除后患者采用股前外侧肌皮瓣及胸大肌游离皮瓣修复再造术均可促进患者语言功能改善,但股前外侧肌游离皮瓣修复再造术在缩短术后恢复时间、改善运动功能及吞咽功能,减少并发症发生方面的效果更佳。Objective To investigate the effect of freeflap and tongue reconstruction on motor function and speech function in patients with tongue carcinoma resection.Methods Eighty-six patients with tongue cancer treated in the author's hospital from January 2020 to May 2022 were selected.The defect was repaired by different methods according to the wound condition.Pectoralis major myocutaneousflap was used to repair the defect in patients with poor peripheral blood vessel condition and large defect tissue.The anterolateral femoral musculocutaneous flap was selected to repair the defect with good peripheral vascular status,relatively small defect tissue and the area that theflap could cover was matched with the defect after tongue resection.They were divided into anterolateral thigh myocutaneous flap group(n=43)and pectoralis major myocutaneousflap group(n=43).Results There was no inflammation in and around theflap area in the two groups,and the tongue body shape was normal.All the patients survived.The color,texture,elasticity and skin of the transplanted flap were good.The postoperative recovery time of anterolateral femoral myocutaneousflap group was significantly shorter than that of thoracic major myocutaneous flap group(P<0.05).Compared with preoperative results,lingual muscle movement scores in 2 groups were improved at 2 months,4 months and 6 months after surgery(P<0.05),and lingual muscle movement scores in anterolateral femoralflap group were significantly higher than those in pectoralis majorflap group(P<0.05).Phonogram(phonetic intelligibity,phonetic PI),phonogram PI and phonogram PI were significantly improved 6 months after surgery(P<0.05).The MTF score of anterolateral femoral myocutaneous flap group was significantly higher than that of thoracic major myocutaneousflap group(P<0.05).The complication rate of anterolateral femoral myocutaneousflap group(4.65%)was significantly lower than that of thoracic major myocutaneous flap group(20.93%),and the difference was statistically significant(P<0.0

关 键 词：股前外侧肌皮瓣 胸大肌皮瓣 舌再造 运动功能 语言功能 

分 类 号：R739.86[医药卫生—肿瘤]