股前外侧皮瓣修复术对口腔颌面部肿瘤术后缺损的临床疗效及对口腔功能的影响  

Clinical efficacy of anterolateral thigh flap repair for postoperative defects of oral and maxillofacial tumor and its influence on oral function

作　　者：梁易 丁如愿 LIANG Yi;DING Ru-yuan(Department of Oral and Maxillofacial Surgery,School of Stomatology,Nanjing University School of Medicine,Nanjing Stomatological Hospital,Nanjing Jiangsu 211800,China)

机构地区：[1]南京大学医学院附属口腔医院(南京市口腔医院)口腔颌面外科,江苏南京211800

出　　处：《临床和实验医学杂志》2024年第24期2628-2631,共4页Journal of Clinical and Experimental Medicine

基　　金：江苏省重点研发计划(社会发展项目)(编号:BE2022671);南京市卫生科技发展专项资金项目计划(编号:YKK22183);南京大学医学院附属口腔医院3456骨干人才资助项目(编号:0222C111)。

摘　　要：目的研究股前外侧皮瓣(ALTF)修复术治疗口腔颌面部肿瘤术后缺损的临床疗效及对口腔功能的影响。方法回顾性选取2023年1月至12月入南京市口腔医院治疗的口腔颌面部肿瘤术后缺损患者90例,参考术式不同分为ALTF组(ALTF修复术,n=45)与胸大肌组(胸大肌皮瓣修复术,n=45)。比较两组患者的时间指标(皮瓣愈合、经口进食、胃管拔除、皮瓣制作+显微吻合及手术时间)、口腔功能指标评分(正常咬合功能、语言表达能力、咀嚼功能、正常吞咽、口腔容纳水测试、口腔开合功能、正常进食、外形修复)、外观瘢痕[温哥华瘢痕量表(VSS)]评分、外观修复满意度、皮瓣成活率及并发症发生情况。结果ALTF组患者的皮瓣愈合、经口进食、胃管拔除及手术时间分别为(10.29±2.36)d、(19.32±0.59)d、(16.93±2.28)d、(5.98±1.41)h,均短于胸大肌组[(12.41±2.58)d、(20.57±0.78)d、(19.47±2.72)d、(6.94±1.52)h],皮瓣制作+显微吻合时间为(98.71±14.16)min,长于胸大肌组[(82.59±11.25)min],差异均有统计学意义(P<0.05)。ALTF组患者的正常咬合功能、语言表达能力、咀嚼功能、正常吞咽、口腔容纳水测试、口腔开合功能、正常进食及外形修复评分均高于胸大肌组,差异均有统计学意义(P<0.05)。ALTF组患者的VSS评分为(5.31±2.34)分,明显低于胸大肌组[(6.32±1.57)分],差异有统计学意义(P<0.05)。ALTF组修复满意度为97.78%,明显高于胸大肌组(82.22%),差异有统计学意义(P<0.05)。ALTF组患者的皮瓣成活率与胸大肌组比较(93.33%vs.86.67%),差异无统计学意义(P>0.05)。ALTF组患者的色素沉着、瘢痕增生、血肿、感染等总并发症发生率为6.67%,明显低于胸大肌组(24.44%),差异有统计学意义(P<0.05)。结论ALTF修复术治疗口腔颌面部肿瘤术后缺损疗效显著,相较于胸大肌皮瓣修复术可进一步改善患者口腔功能与缩短手术时间,外观瘢痕修复更为理想,外观修复�Objective To study the clinical efficacy of anterolateral thigh flap(ALTF)repair for postoperative defects of oral and maxillofacial tumors and its impact on oral function.Methods A total of 90 patients with postoperative defects of oral and maxillofacial tumors who were admitted to Nanjing Stomatological Hospital from January to December 2023 were retrospectively selected.According to different surgical methods,they were divided into the ALTF group(ALTF repair,n=45)and the pectoralis major muscle group(pectoralis major myocutaneous flap repair,n=45).The time index(flap healing,oral feeding,gastric tube removal,flap production+microanastomosis,and operation time),oral function index score(normal occlusion function,language expression ability,masticatory function,normal swallowing,oral water holding test,oral opening and closing function,normal eating,and appearance repair),appearance scar score[vancouver scar scale(VSS)],appearance repair satisfaction,flap survival rate and complications were compared between the two groups.Results The time of flap healing,oral feeding,gastric tube removal and operation time in the ALTF group were(10.29±2.36)d,(19.32±0.59)d,(16.93±2.28)d and(5.98±1.41)h,respectively,which were shorter than those in the pectoralis major group[(12.41±2.58)d,(20.57±0.78)d,(19.47±2.72)d and(6.94±1.52)h],the time of flap making and microanastomosis was(98.71±14.16)min,which was longer than that of the pectoralis major group[(82.59±11.25)min],and the difference was statistically significant(P<0.05).The scores of normal occlusion function,language expression ability,chewing function,normal swallowing,oral water holding test,oral opening and closing function,normal eating and shape repair in the ALTF group were higher than those in the pectoralis major group,and the differences were statistically significant(P<0.05).The VSS score of the ALTF group was(5.31±2.34)points,which was significantly lower than that of the pectoralis major group[(6.32±1.57)points],and the difference was statistically

关 键 词：口腔颌面部肿瘤 术后缺损 股前外侧皮瓣修复术 临床疗效 口腔功能 

分 类 号：R47[医药卫生—护理学]