微血管吻合器在股前外侧皮瓣修复口腔恶性肿瘤术后缺损中的应用效果  

Application of microvascular coupler in anterolateral thigh flap for repairing postoperative defects after oral malignant tumor surgery

作　　者：孟宇翔 宋凯[1,2] 何宗轩 王琳[1,2] 葛胜优 魏晨珂 尚伟[1,2] MENG Yu-xiang;SONG Kai;HE Zong-xuan;WANG Lin;GE Sheng-you;WEI Chen-ke;SHANG Wei(Department of Oral and Maxillofacial Surgery,Affiliated Hospital of Qingdao University,Qingdao 266003;School of Stomatology,Qingdao University,Qingdao 266003,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

出　　处：《中国口腔颌面外科杂志》2024年第3期268-273,共6页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的:通过对比股前外侧皮瓣修复口腔恶性肿瘤术后缺损中血管吻合方法的差异,分析使用微血管吻合器与手工吻合方法对肺部感染的影响,并评估肺部感染相关的危险因素。方法:回顾分析2019年1月—2022年10月在青岛大学附属医院口腔颌面肿瘤外科接受股前外侧皮瓣行下颌骨缺损修复的92例患者,其中吻合器组42例,手工吻合组50例。术后随访12个月,评估术后合并肺部感染的危险因素。采用SPSS 22.0软件包对数据进行统计学分析。结果:吻合器组行单静脉吻合术28例,双静脉吻合术11例,动脉和静脉均吻合3例。54(54/56,96.43%)个吻合器被成功使用进行吻合,2例分别因术中动脉吻合口痉挛、静脉吻合后内径明显缩小而放弃。所有患者均未发生皮瓣失败,皮瓣总成活率为100%。吻合器组与手工吻合组相比,术后肺部感染率虽无统计学差异,但有明显降低趋势。另外在吻合器组,糖尿病与术后白蛋白<30 g/L并非肺部感染的危险因素,而与吸烟、年龄、ACE-27评分显著相关。吻合器的使用有助于降低平均住院日,由平均11.1天降至8.9天。结论:合理的血管吻合器使用具有高的皮瓣成活率且对降低术后肺部感染以及平均住院日有积极作用,但仍需更多的大型随机临床试验进行研究。PURPOSE:By comparing the difference of vascular anastomosis methods in repairing oral defects after malig-nant tumors with anterolateral thigh flap,to analyze the effect of microvascular stapler and manual anastomosis on pul-monary infection,and to evaluate the risk factors related to pulmonary infection.METHODS:A retrospective analysis was conducted on 92 patients(42 in the stapler group and 50 in the manual anastomosis group)who underwent mandibular re-construction with anterolateral thigh flaps in the Department of Oral and Maxillofacial Surgery of Qingdao University Af-filiated Hospital from January 2019 to October 2022.A follow-up visit was conducted 12 months after surgery to assess the risk factors for postoperative pulmonary infection.SPSS 22.0 software package was used for data analysis.RESULTS:In microvascular coupler group,single-vein anastomoses were performed in 28 patients,double-vein anastomoses in 11 patients and both arterie and vein anastomoses in 3 patients.Anastomoses were completed successfully using the coupler in 54 out of 56 attempted cases(96.43%),2 microvascular couplers were abandoned because 1 had arterial spasm and 1 had anastomotic stricture leading to coupler loose during the operation.As expected,no flap failures occurred in these cases,resulting in an overall flap success rate of 100%.Compared with the manual anastomosis group,there was no significant difference in postoperative pulmonary infection rate,but there was a significant decrease trend.In addition,in the stapler group,diabetes and postoperative albumin<30 g/L were not risk factors for pulmonary infection,but were significantly associated with smoking,age,and ACE-27 score.The use of staplers helped reduce the average length of stay from 11.1 days to 8.9 days.CONCLUSIONS:Reasonable use of vascular coupler has a high flap survival rate and a positive effect on reducing postoperative pulmonary infection and the average length of hospital stay,but more large randomized clinical trials are still needed for further research.

关 键 词：下颌骨缺损修复 微血管吻合器 游离皮瓣 肺部感染 

分 类 号：R782.05[医药卫生—口腔医学]