Analysis of the effect of free posterior lateral peroneal artery perforator flap of lower leg in repairing oropharyngeal cancer
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摘要: 目的 分析游离小腿后外侧腓动脉穿支皮瓣修复口咽癌术后缺损的临床效果。方法 对2016年6月—2019年6月蚌埠医学院第一附属医院口腔颌面外科收治的36例口咽癌患者进行分析和随访，18例患者采用游离小腿后外侧腓动脉穿支皮瓣修复术后缺损(实验组)，18例采用游离前臂皮瓣修复(对照组)，比较两组患者移植皮瓣成活率、伤口Ⅰ期愈合率及平均住院时间；采用Kaplan-Meier法计算患者术后1、3年生存率，log-rank检验比较两组生存曲线间差异；通过洼田饮水试验、吹气法计算并统计分析两组患者术后3、6、12、18个月吞咽、腭咽闭合功能恢复情况。结果 实验组与对照组均有1例皮瓣坏死，成活率均为94.4%；两组患者术区伤口Ⅰ期愈合率均为94.4%；实验组和对照组供区伤口愈合率分别为100.0%和94.4%；实验组和对照组平均住院时间分别为16.9 d和17.2 d，差异无统计学意义(P＞0.05)。所有患者1、3年总体生存率为91.2%、66.5%；实验组和对照组1、3年生存率分别为94.1%、69.3%和88.2%、63.7%，两组比较差异无统计学意义(P＞0.05)；P16+和P16-患者术后1、3年生存率分别为100.0%、80.0%和85.7%、64.3%，两组比较差异无统计学意义(P＞0.05)。术后3、6个月两组患者吞咽及腭咽闭合功能恢复评价的差异无统计学意义(P＞0.05)，术后12、18个月差异有统计学意义(P＜0.05)。结论 游离小腿后外侧腓动脉穿支皮瓣穿支血管解剖恒定，可根据组织缺损空间制备成单叶、多叶、嵌合等皮瓣，且供区隐蔽可直接拉拢缝合，同时该皮瓣可塑性较强，因此可作为修复口咽癌术后缺损的常用皮瓣。Abstract: Objective To analyze the clinical effect of free posterior lateral peroneal artery perforator flap of lower leg in repairing postoperative defect of oropharyngeal carcinoma.Methods Thirty-six patients with oropharyngeal carcinoma admitted to the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College from June 2016 to June 2019 were analyzed and followed up, eighteen patients were treated with free posterior lateral peroneal artery perforator flap of the lower leg to repair the postoperative defects(experimental group), and eighteen patients were treated with free forearm flap(control group). The survival rate of the transplanted flap, the wound stageⅠhealing rate and average hospitalization time were compared between the two groups. Kaplan-Meier method was used to calculate the 1-year and 3-year survival rates of patients after operation, and log-rank test was used to compare the difference between the survival curves of the two groups; The recovery of swallowing and palatopharyngeal closure function of patients in the two groups at 3, 6, 12 and 18 months after operation was calculated and statistically analyzed through the water swallow test and the air blowing method.Results There was one case of skin flap necrosis in both the experimental group and the control group, and the survival rate was 94.4%. The wound stageⅠhealing rate in the surgical area was 94.4% in both groups. The wound healing rates of the donor area in the experimental group and the control group were 100.0% and 94.4% respectively. The average hospitalization time of the experimental group and the control group was 16.9 days and 17.2 days, respectively, with no significant difference (P > 0.05). The overall survival rates of all patients at 1-year and 3-year were 91.2% and 66.5% respectively; The 1-year and 3-year survival rates of the experimental group and the control group were 94.1%, 69.3% and 88.2%, 63.7%, respectively, and there was no significant difference between the two groups (P > 0.05). The 1-year and 3-year survival rates of P16+ and P16 - patients were 100.0%, 80.0% and 85.7%, 64.3%, respectively, and there was no significant difference between the two groups (P > 0.05). There was no significant difference in the evaluation of swallowing and velopharyngeal closure function between the two groups at 3 and 6 months after operation (P > 0.05), but there was a significant difference at 12 and 18 months after operation (P < 0.05).Conclusion The anatomic position of the perforating vessels of the free posterior lateral peroneal artery perforator flap of the lower leg is constant, and it can be prepared into single leaf, multi leaf, chimeric and other flaps according to the tissue defect space. And the concealed supply area can be directly drawn to suture. At the same time, the skin flap has strong plasticity. Therefore, the skin flap can be used as a common skin flap to repair the defects after the operation of oropharyngeal carcinoma.
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表 1 两组患者一般资料比较
例(%) 项目 对照组(n=18) 实验组(n=18) χ2 P值 项目 对照组(n=18) 实验组(n=18) χ2 P值 性别 0.120 0.729 病理分级 1.453 0.693 男 11(61.1) 12(66.7) 高分化 4(22.2) 6(33.3) 女 7(38.9) 6(33.3) 中分化 10(55.6) 9(50.0) 发病部位 0.521 0.914 低分化 3(16.7) 3(16.7) 扁桃体 5(27.8) 4(22.2) 未分化 1(5.6) 0(0) 舌根 7(38.9) 6(33.3) HPV分型 0.177 0.674 软腭 5(27.8) 7(38.9) HPV+ 4(22.2) 3(16.7) 咽后壁 1(5.6) 1(5.6) HPV- 14(77.8) 15(83.3) cTNM分期 0.582 0.748 清扫范围 0.170 0.919 Ⅱ期 2(11.1) 2(11.1) Ⅰ~Ⅲ区 5(27.8) 5(27.8) Ⅲ期 12(66.7) 10(55.6) Ⅰ~Ⅳ区 8(44.4) 9(50.0) Ⅳ期 4(22.2) 6(33.3) Ⅰ~Ⅴ区 5(27.8) 4(22.2) T分期 1.209 0.598 术后放疗剂量/Gy 0.253 0.881 T1~T2 2(11.1) 3(16.7) 44~50 9(50.0) 10(55.6) T3 12(66.7) 9(50.0) 54~63 6(33.3) 6(33.3) T4a 4(22.2) 6(33.3) 60~66 3(16.7) 2(11.1) N分级 1.117 0.773 N0 3(16.7) 2(11.1) N1 9(50.0) 7(38.9) N2 5(27.8) 7(38.9) N3 1(5.6) 2(11.1) 
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表 2 术后两组患者吞咽功能恢复评价比较
随访时间/月 对照组 实验组 χ2 P值 正常 可疑 异常 正常 可疑 异常 3 0 5 12 0 7 10 0.515 0.473 6 1 11 5 2 11 3 0.804 0.669 12 2 11 2 10 5 1 7.893 0.019 18 8 6 0 14 0 1 8.612 0.013
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表 3 术后两组患者腭咽闭合功能恢复评价比较
随访时间/月 对照组 实验组 χ2 P值 正常 可疑 异常 正常 可疑 异常 3 0 6 11 0 8 9 0.486 0.486 6 1 8 8 3 8 5 1.664 0.435 12 3 9 3 11 4 1 7.470 0.024 18 8 6 0 14 1 0 5.179 0.023
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