颏下岛状瓣和前臂皮瓣在舌根缺损修复中的临床应用  

Clinical application of submental island flap and radial forearm free flap in the repair of tongue base defects

作　　者：马乐天 米热吉罕·司地克 胡露露[2] 龚忠诚[2] MA Letian;Mirejihan Sidike;HU Lulu;GONG Zhongcheng(Department of Stomatology,People's Hospital of Fushun County,Zigong,Sichuan,643000,China;Oncological Department of Oral and Maxillofacial Surgery,the First Affiliated Hospital of Xinjiang Medical University,School/Hospital of Stomatology Xinjiang Medical University;Stomatological Research Institute of Xinjiang Uygur Autonomous Region,Urumqi,830054,China)

机构地区：[1]富顺县人民医院口腔科,四川自贡643000 [2]新疆医科大学第一附属医院(附属口腔医院)口腔颌面肿瘤外科,新疆维吾尔自治区口腔医学研究所,乌鲁木齐830054

出　　处：《新疆医学》2025年第3期273-279,共7页Xinjiang Medical Journal

基　　金：新疆维吾尔自治区天山创新团队(项目编号:2021D14001);自治区自然科学基金面上项目(项目编号:2022D01C482)。

摘　　要：目的通过比较A组与B组术中、术后及生存质量的差异,探讨两组手术路径的优势和局限,评价不同皮瓣的修复效果。方法回顾性分析2015年1月-2022年12月收治的12例经手术治疗与皮瓣重建的舌根肿瘤患者,根据手术路径及重建皮瓣的不同将其分为A组(舌骨上咽切开入路联合颏下岛状瓣修复),B组(下颌骨切开入路联合前臂皮瓣修复);比较两组患者术中、术后相关指标及患者术后生存质量等情况。结果A组的手术时间、皮瓣制备时间、皮瓣面积及术中出血量显著低于B组(P<0.05);术后A组住院花费显著低于B组(P<0.05),术后1天A组白细胞介素-6显著低于B组(P<0.05);两组患者术后生存质量无明显差异。结论舌骨上咽切开入路较下颌骨切开入路手术时间短,术中创伤小,手术相关并发症少;两者在选择恰当适应症的情况下均可以充分暴露舌根肿瘤。颏下岛状瓣和前臂皮瓣均是舌根缺损修复的理想皮瓣,前者适用于较小缺损的修复,对于组织缺损较为严重的患者,前臂皮瓣更加合适。Objective To explore the advantages and limitations of the surgical pathways of the two groups by comparing the differences in intraoperative,postoperative and survival quality between Group A and Group B,and to evaluate the repair effect of different flaps.Methods Retrospective analysis of 12 patients with tongue root tumors treated with surgical treatment and flap reconstruction admitted from January 2015 to December 2022 were divided into Group A(suprahyoid pharyngotomy combined with submental island flap repair)and Group B(mandibular osteotomy combined with radial forearm free flap)according to the different surgical paths and reconstructed flaps;the intra-operative and post-operative related indexes and the patients'post-operative survival quality were compared between the two groups.Results The operating time,flap preparation time,flap area and intraoperative bleeding in group A were significantly lower than those in group B(P<0.05);the hospitalization cost in group A was significantly lower than that in group B(P<0.05).interleukin-6 was significantly lower in group A than in group B(P<0.05);there was no significant difference in the quality of patients'survival after the operation in the two groups.Conclusion The suprahyoid pharyngotomy is shorter than the mandibulotomy approach,with less intraoperative trauma and fewer surgery-related complications;both can adequately expose the tongue base tumor when appropriate indications are selected.Both the submental island flap and the radial forearm free flap are ideal flaps for repair of tongue base defects;the former is suitable for repair of smaller defects,and the the radial forearm free flap is more appropriate for patients with more severe tissue defects.

关 键 词：舌根肿瘤 舌骨上咽切开入路 颏下岛状瓣 下颌骨切开入路 前臂皮瓣 

分 类 号：R782[医药卫生—口腔医学]