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腓动脉穿支游离皮瓣在口腔癌术后复杂缺损中的临床应用

[Clinical application of free peroneal artery leaflet perforator flap in postoperative complex defect of oral cancer].

作者信息

Wang Xuji, Zhuo Feng, Liu Sen, Li Jiancheng, Cui Wenjing, Hu Kai, Chen Mo

机构信息

Department of Oral and Maxillofacial Surgery,the First Affiliated Hospital of Bengbu Medical University,Bengbu,233004,China.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 Aug;38(8):737-742. doi: 10.13201/j.issn.2096-7993.2024.08.012.

Abstract

To investigate the clinical effect of a segmented perforator flap of free peroneal artery to repair a complex defect after oral cancer. 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(>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. 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 (>0.05). According to the results of the functional recovery evaluation, the groups in swallowing and speech function and subjective satisfaction(>0.05), and at 12 months after surgery(<0.05). 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.

摘要

探讨游离腓动脉穿支分叶皮瓣修复口腔癌术后复合组织缺损的临床效果。选取2018年1月至2022年1月蚌埠医学院第一附属医院口腔颌面外科收治的48例口腔癌患者,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。病变切除后,试验组24例采用部分穿支皮瓣修复缺损,对照组24例采用单叶皮瓣修复缺损。两组一般资料比较,差异无统计学意义(>0.05),具有可比性。试验组皮瓣切取面积为38.5~74.5 cm²,供区行减张缝合。对照组肌皮瓣切取面积为61.0~76.5 cm²,供区行植皮缝合。记录并比较皮瓣存活情况及患者生存情况。术后6个月、12个月对患者进行随访,分别评估其吞咽功能和言语功能,包括饮水试验、功能性口腔摄食量表及汉语清晰度测试词表,并记录其对修复外观的主观满意度。两组患者随访12~60个月。采用Kaplan-Meier法计算患者累积生存率并绘制生存曲线,采用log-rank检验比较组间生存曲线。两组患者生存率均为100%。试验组5年生存率为62.5%,对照组为54.2%,两组比较差异无统计学意义(>0.05)。根据功能恢复评估结果,两组在吞咽和言语功能及主观满意度方面术后即刻差异无统计学意义(>0.05),术后12个月差异有统计学意义(<0.05)。游离腓动脉穿支分叶皮瓣灵活性高,可修复口腔癌术后复合组织缺损的不同解剖结构,能有效提高术后功能恢复及患者满意度。因此,腓动脉穿支分叶皮瓣是修复口腔癌术后复合组织缺损的理想皮瓣。

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