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,外观修复满意度更高,且并发症更少,安全性更高.
Abstract
Objective To study the clinical efficacy of anterolateral thigh flap(ALTF)repair for postoperative defects of oral and maxillo-facial 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 satisfac-tion,flap survival rate and complications were compared between the two groups.Results The time of flap healing,oral feeding,gastric tube re-moval 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,respective-ly,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 abili-ty,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 significant(P＜0.05).The repair satisfaction of the ALTF group was 97.78％,which was significantly higher than that of the pectoralis major group(82.22％),and the difference was statistically significant(P＜0.05).There was no statistically significant difference in flap survival rate between the ALTF group and the pectoralis major group(93.33％vs.86.67％)(P＞0.05).The incidence of to-tal complications such as pigmentation,scar hyperplasia,hematoma and infection in the ALTF group was 6.67％,which was significantly lower than that in the pectoralis major group(24.44％),and the difference was statistically significant(P＜0.05).Conclusion ALTF repair is ef-fective in the treatment of defects after oral and maxillofacial tumor surgery.Compared with pectoralis major myocutaneous flap repair,ALTF repair can further improve the oral function of patients,shorten the operation time,and has more ideal appearance scar repair,higher satisfaction of ap-pearance repair,fewer complications,and higher safety.
维普
万方数据