Schultze-Mosgau S, Erbe M, Keilholz L, Radespiel-Tröger M, Wiltfang J, Minge N, Neukam F W
Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Germany.
Int J Oral Maxillofac Surg. 2000 Apr;29(2):112-8.
The aim of the study was to investigate, histomorphometrically, quantitative and qualitative changes in irradiated neck recipient vessels and transplant vessels used for microsurgical anastomoses in free flaps in patients undergoing preoperative radiotherapy and chemotherapy. In 55 patients receiving 42 radial forearm flaps, 6 latissimus dorsi flaps, 6 osteomyocutaneous fibula grafts and 1 lateral arm flap, a total of 220 vessels were obtained from neck recipient vessels and transplant vessels during anastomosis. Three groups were formed: Group 1 (16 patients) treated with no radiotherapy or chemotherapy; Group 2 (20 patients) treated with preoperative irradiation (40-50 Gy) and chemotherapy (800 mg/m2 5-FU and 20 mg/m2 cisplatin) 1.5 months prior to surgery; Group 3 (19 patients) treated with radiotherapy (60-70 Gy) (median interval 78.7 months; IQR 31.3 months) prior to surgery. From each of the 220 vessel specimens, 3 sections each were histomorphometrically investigated, both qualitatively and quantitatively. To evaluate these changes as a function of age, radiation dose and chemotherapy, a statistical analysis was performed using analysis of covariance and chi-square tests. In Group 3, qualitative changes (intima dehiscence, hyalinosis) were found in recipient arteries significantly more frequently (25%, P=0.009) than in Groups 1 and 2. For Group 3 recipient arteries, histomorphometry revealed a significant decrease in the ratio of media area/total vessel area (median 0.53, IQR 0.10) in comparison with Group 1 (P= 0.02) (median 0.60, IQR 0.29) and Group 2 (P=0.046) (median 0.59, IQR 0.10). No significant differences were found between the vessels of Groups 1 and 2 (P= 0.48). Age and chemotherapy did not appear to have a significant influence on vessel changes in this study.
本研究的目的是通过组织形态计量学方法，调查接受术前放疗和化疗的患者，其用于游离皮瓣显微外科吻合的颈部受区血管和移植血管的定量和定性变化。在55例接受手术的患者中，共获取了42块桡侧前臂皮瓣、6块背阔肌皮瓣、6块腓骨骨肌皮瓣和1块上臂外侧皮瓣，在吻合过程中从颈部受区血管和移植血管共获取了220条血管。将患者分为三组：第1组（16例）未接受放疗或化疗；第2组（20例）在手术前1.5个月接受术前放疗（40 - 50 Gy）和化疗（800 mg/m² 5-氟尿嘧啶和20 mg/m²顺铂）；第3组（19例）在手术前接受放疗（60 - 70 Gy）（中位间隔时间78.7个月；四分位间距31.3个月）。对220个血管标本中的每一个，均进行3个切片的组织形态计量学研究，包括定性和定量分析。为了评估这些变化与年龄、辐射剂量和化疗的关系，使用协方差分析和卡方检验进行统计分析。在第3组中，受区动脉出现定性变化（内膜裂开、玻璃样变性）的频率显著高于第1组和第2组（25%，P = 0.009）。对于第3组受区动脉，组织形态计量学显示，与第1组（P = 0.02）（中位值0.60，四分位间距0.29）和第2组（P = 0.046）（中位值0.59，四分位间距0.10）相比，中膜面积/血管总面积的比值显著降低（中位值0.53，四分位间距0.10）。第1组和第2组的血管之间未发现显著差异（P = 0.48）。在本研究中，年龄和化疗似乎对血管变化没有显著影响。
