Clinical application of free peroneal artery leaflet perforator flap in postoperative complex defect of oral cancer
-
摘要: 目的 探讨游离腓动脉分叶穿支皮瓣修复口腔癌术后复合性缺损的临床效果。方法 选取2018年1月—2022年1月蚌埠医科大学第一附属医院口腔颌面外科收治的口腔癌患者48例，其中颊癌8例、口底癌7例、舌癌14例、磨牙后区癌5例，上颌牙龈癌9例，下颌牙龈癌5例。病灶切除术后，实验组24例采用腓动脉分叶穿支皮瓣修复缺损，对照组24例采用腓动脉单叶穿支皮瓣修复缺损。术中实验组皮瓣切取范围为38.5~74.5 cm2，供区减张缝合；对照组皮瓣切取范围为61.0~76.5 cm2，供区植皮缝合。记录并比较2组皮瓣成活以及患者存活情况。术后6个月及12个月分别对患者进行门诊随访，利用洼田饮水试验、功能性经口摄食量表和汉语语言清晰度测试字表分别对患者吞咽功能、语音功能进行评价，并记录患者对修复外形的主观满意度。2组患者均获随访，随访12~60个月，利用Kaplan-Meier法计算患者累积生存率，绘制生存曲线，采用log-rank检验进行组间生存曲线比较。结果 2组皮瓣成活率均为100%。术后5年实验组患者生存率为62.5%，对照组为54.2%，2组差异无统计学意义(P>0.05)。2组患者术后6个月的吞咽功能、语音功能及主观满意度比较差异均无统计学意义(P>0.05)；术后12个月，2组差异均有统计学意义(P<0.05)。结论 游离腓动脉分叶穿支皮瓣可分别修复口腔癌术后复合缺损的不同解剖结构，可有效提高术后功能恢复程度和患者满意度。腓动脉分叶穿支皮瓣是重建口腔癌术后复合缺损的理想皮瓣。Abstract: Objective To investigate the clinical effect of a segmented perforator flap of free peroneal artery to repair a complex defect after oral cancer.Methods Forty-eight patients with oral cancer admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2018 to January 2022, including 8 of buccal cancer, 7 of floor cancer, 14 of tongue cancer, 5 of retromolar cancet, 9 of maxillary gingival cancer and 5 of mandibular gingival cancer. After lesion resection, 24 patients in the experimental group used the partial perforator flap to repair the defect, and 24 patients in the control group used the single flap to repair the defect. Compared with the general data of the two groups, the difference was not statistically significant(P>0.05), which was comparable. The flap cutting range of the experimental group was 38.5-74.5 cm2, and tension-reduced suture for the donor area. In the control group, the myocutaneous flap incision range was 61.0-76.5 cm2, and skin graft suture for the donor area. Flap survival and patient survival were recorded and compared. The patients were followed up at 6 and 12 months after surgery, and their swallowing function and speech function, including the drinking water test, functional oral food intake scale and the Chinese language clarity test word table, were evaluated respectively, and their subjective satisfaction with the repair appearance was recorded. Patients in both groups were followed up for 12 to 60 months. Kaplan-Meier method was used to calculate the cumulative survival rate of patients, and survival curves were plotted. log-rank test was used to compare the survival curves between groups.Results The survival rate of the two groups was 100%. The 5-year survival rate was 62.5% in the experimental group and 54.2% in the control group. There was no significant difference between the two groups (P>0.05). According to the results of the functional recovery evaluation, the groups in swallowing and speech function and subjective satisfaction(P>0.05), and at 12 months after surgery(P<0.05).Conclusion The segmented perforator flap of free peroneal artery is flexible and can repair different anatomical structures of postoperative composite defect of oral cancer, which can effectively improve postoperative functional recovery and patient satisfaction. Therefore, the peroneal artery segmented perforator flap is the ideal flap for reconstructing postoperative composite defect of oral cancer.
-
Key words:
- leaf perforator flap /
- oral cancer /
- composite defect /
- repair and reconstruction /
- peroneal artery
-
-
表 1 2组患者一般资料
例(%) 项目 实验组(n=24) 对照组(n=24) 年龄/岁 60.50±10.66 62.08±9.06 性别 男 16(66.7) 14(58.3) 女 8(33.3) 10(41.7) 发病部位 颊癌 4(16.7) 4(16.7) 口底癌 3(12.5) 4(16.7) 舌癌 7(29.2) 7(29.2) 磨牙后区癌 2(8.3) 3(12.5) 上颌牙龈癌 5(20.8) 4(16.7) 下颌牙龈癌 3(12.5) 2(8.3) T分期 T3 14(58.3) 12(50.0) T4a 8(33.3) 10(41.7) T4b 2(8.3) 2(8.3) N分级 N0 2(8.3) 2(8.3) N1 16(66.7) 14(58.3) N2 6(25.0) 8(33.3) 临床分期 Ⅲ期 14(58.3) 12(50.0) Ⅳa期 8(33.3) 10(41.7) Ⅳb期 2(8.3) 2(8.3) 
下载: 导出CSV
表 2 各类功能的评价
例 实验类型 随访时间/月 实验组 对照组 t P 优 良 差 优 良 差 饮水试验 6 6 14 4 2 12 10 4.725 0.094 12 16 8 0 4 14 6 14.836 0.001 FOIS 6 14 8 2 10 10 4 1.556 0.459 12 20 4 0 8 14 2 12.698 0.002 语音功能 6 8 10 6 2 12 10 4.782 0.092 12 18 6 0 6 16 2 12.545 0.002 主观满意 6 10 12 2 4 16 4 3.810 0.149 12 18 6 0 6 18 0 12.000 0.001
下载: 导出CSV
-
[1] Xie L, Shang Z. Changing trend of oral cancer disease burden in China from 1990 to 2019 and the forecast for the next 20-years[J]. Oral Dis, 2024, 30(2): 195-206. doi: 10.1111/odi.14450
[2] Moeckelmann N, Ebrahimi A, Tou YK, et al. Prognostic implications of the 8th edition American Joint Committee on Cancer(AJCC)staging system in oral cavity squamous cell carcinoma[J]. Oral Oncol, 2018, 85: 82-86. doi: 10.1016/j.oraloncology.2018.08.013
[3] Pfister DG, Spencer S, Adelstein D, et al. Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr Canc Netw, 2020, 18(7): 873-898. doi: 10.6004/jnccn.2020.0031
[4] 涂晓敏, 任建君, 赵宇. 头颈鳞状细胞癌危险因素及遗传风险的研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(5): 391-396. doi: 10.13201/j.issn.2096-7993.2022.05.015
[5] 尚伟, 郑家伟. 口腔及口咽癌新版TNM分期与NCCN诊治指南部分解读[J]. 中国口腔颌面外科杂志, 2018, 16(6): 533-546. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKQ201806014.htm
[6] Koyfman SA, Ismaila N, Crook D, et al. Management of the Neck in Squamous Cell Carcinoma of the Oral Cavity and Oropharynx: ASCO Clinical Practice Guideline[J]. J Clin Oncol, 2019, 37(20): 1753-1774. doi: 10.1200/JCO.18.01921
[7] 唐举玉. 特殊形式穿支皮瓣及其衍生术式的分型与命名[J]. 中华显微外科杂志, 2021, 44(3): 245-254. doi: 10.3760/cma.j.cn441206-20210530-00193
[8] 郭家平, 王翔. 游离皮瓣移植术对口腔颌面部肿瘤切除术后缺损的修复研究[J]. 实用癌症杂志, 2019, 31(6): 915-917. doi: 10.3969/j.issn.1001-5930.2019.06.013
[9] 李建成, 宋培军, 杨东昆, 等. 小腿后外侧腓动脉双叶穿支游离皮瓣修复口腔颌面部恶性肿瘤术后面部洞穿性缺损[J]. 中华显微外科杂志, 2019, 42(1): 26-31.
[10] Li J, Song P, Yang D, et al. Complicated intraoral defects: reconstruction using a three-paddle perforator free flap. A case report[J]. Br J Oral Maxillofac Surg, 2020, 58(3): 355-357. doi: 10.1016/j.bjoms.2019.10.318
[11] 李建成, 宋培军, 杨东昆, 等. 游离腓动脉双叶穿支皮瓣在晚期口咽癌术后缺损解剖重建中的临床效果[J]. 南方医科大学学报, 2020, 40(6): 814-821. https://www.cnki.com.cn/Article/CJFDTOTAL-DYJD202006008.htm
[12] 李建成, 宋培军, 杨东坤, 等. 游离小腿后外侧穿支皮瓣在口腔颌面部组织缺损修复重建中的应用[J]. 中华显微外科杂志, 2017, 40(3): 248-251. doi: 10.3760/cma.j.issn.1001-2036.2017.03.011
[13] 孙悦, 郭蕴, 李建成, 等. 游离小腿后外侧腓动脉穿支皮瓣在全舌、次全舌切除术后修复中的临床应用[J]. 中华整形外科杂志, 2021, 37(11): 1214-1221. doi: 10.3760/cma.j.cn114453-20201010-00526
[14] 杨东昆, 李建成, 吴志刚, 等. 游离腓动脉嵌合穿支皮瓣修复腮腺癌晚期局部病变术后缺损[J]. 中国修复重建外科杂志, 2022, 36(1): 79-85. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXCW202201009.htm
[15] 郭蕴, 崔文静, 宗开洋, 等. 红外热成像技术辅助腓动脉穿支皮瓣修复口腔颌面部缺损的应用研究[J]. 中国修复重建外科杂志, 2022, 36(8): 1015-1020. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXCW202208015.htm
[16] 王婷, 程金梅. 心理护理干预对面部整形美容手术患者心理状态及手术满意度的影响研究[J]. 中国美容医学, 2021, 30(6): 168-170. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX202106048.htm
[17] 王娜, 谭丽双, 李宇. 口腔癌患者术后吞咽障碍评价与其早期预后的相关性研究[J]. 中国实用口腔科杂志, 2021, 14(1): 81-84. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSKQ202101021.htm
[18] 朱亚芳, 张晓梅, 张钦缔, 等. 中文版经口摄食功能评估量表在摄食-吞咽障碍脑卒中患者中的信效度检验[J]. 实用医学杂志, 2017, 33(22): 3826-3829. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ201722040.htm
[19] 肖育栋, 郭凯欣, 杨乐, 等. 369例口腔癌患者汉语普通话语音数据库的建立与初步评价[J]. 中国口腔颌面外科杂志, 2022, 20(2): 151-157. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKQ202202009.htm
[20] Chaput B, Meresse T, Bekara F, et al. Lower limb perforator flaps: Current concept[J]. Ann Chir Plast Esthet, 2020, 65(5-6): 496-516.
[21] Song P, Liang Q, Qian Y, Li J. Analysis of Survival Quality of Peroneal Artery Perforator Flap in Immediate Repairment and Reconstruction of Oral and Maxillofacial Malignancies[J]. J Craniofac Surg, 2023, 34(5): e474-e477.
[22] Christopher H, Maddie T, Wesley E, et al. The medial sural artery perforator flap: translation from anatomic study to clinical application for lower extremity reconstruction[J]. Eur J Surg, 2023, 46(6): 1265-1272.
[23] Lei B, Zhong Y, Chen Z, et al. Application of Composite Tissue Flap Pedicled With Superficial Temporal Artery and its Branches in the Repair of Various Maxillofacial Defects[J]. J Craniofac Surg, 2023, 34(2): 515-519.
[24] 崔文静, 卓凤, 王续纪, 等. 游离小腿后外侧腓动脉穿支皮瓣修复口咽癌术后缺损的效果分析[J]. 临床耳鼻咽喉头颈外科杂志, 2023, 37(1): 52-58, 62. doi: 10.13201/j.issn.2096-7993.2023.01.010
[25] 张子阳, 金文虎, 全辉, 等. 腓动脉穿支嵌合组织瓣的影像学研究及临床应用[J]. 中国修复重建外科杂志, 2022, 36(4): 446-450. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXCW202204010.htm
[26] Liu K, Zhang W, Wang Y, et al. Fibula osteal flap with proximal peroneal perforator skin paddle for composite oromandibular reconstruction: A case report[J]. Medicine(Baltimore), 2020, 99(50): e23590.
[27] 方杰, 陈步国, 吴尧, 等. 腓肠内侧动脉穿支皮瓣临床应用研究进展[J]. 中国修复重建外科杂志, 2021, 35(4): 508-513. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXCW202104020.htm
[28] 李海, 肖顺娥, 邓呈亮, 等. 游离分叶穿支皮瓣修复四肢复杂创面[J]. 中国修复重建外科杂志, 2022, 36(1): 98-101. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXCW202201012.htm
[29] 李建成, 郭蕴, 崔文静, 等. 局部中晚期口腔癌治疗方式与生存质量的分析[J]. 癌症, 2022, 41(9): 434-442. https://www.cnki.com.cn/Article/CJFDTOTAL-AIZH202209003.htm
-
计量
- 文章访问数: 402
- 施引文献: 0