口腔颌面部缺损的修复重建--1 973例临床分析

目的 口腔颌面部缺损游离组织瓣修复方式的对比研究。方法 2001年1月～2004年6月，收集修复重建患者共1973例，分别对其年龄、性别、病种、缺损部位和修复类型的分布情况，游离组织瓣危象的发生率及成功率进行分类统计。采用SAS6．12医用统计软件包进行数据分析。结果 中年（〉45～≤60岁）患者764例，占38.72％；老年（〉60岁）527例，占26．71％；青壮年（〉28～≤45岁）450例，占22．81％；青年（〉14≤28岁）187例，占9．48％，儿童（≤14岁）45例，占2．28％。男1193例，女780例，男、女之比为1．5：1。良、恶性病变之比为1：1．94。缺损部位依次为舌20．63％、下颌骨17．38％、腮腺13．74％、颊12．72％、上颌骨8．16％、口咽7．60％、口底5.68％、其他占14．09％。血管化游离组织瓣修复904例，占45．82％；带蒂组织瓣753例，占38．17％；随意（皮）瓣201例，占10．19％；非血管化骨移植30例，占1．52％；其它方法85例，占4．30％。其中游离前臂皮瓣594例，腓骨肌（皮）瓣143例，带蒂胸大肌（皮）瓣369例，3种组织瓣共1106例，占修复重建总例数的56．06％。游离组织瓣共940个，发生术后危象47个（5．20％），抢救成功30个（63．83％），游离组织瓣总成功率为98．19％。结论 口腔颌面部缺损修复重建患者以中老年、男性、恶性肿瘤为主；舌的缺损修复约占1／5；游离组织瓣的成功率高，是主要的修复方式；前臂皮瓣、腓骨肌（皮）瓣、带蒂胸大肌（皮）瓣成为口腔颌面部缺损修复的常用组织瓣。

REPAIR AND RECONSTUCTION OF ORAL AND MAXILLOFACIAL DEFECT--CLINICAL ANALYSIS OF 1 973 CASES

OBJECTIVE: To compare the reconstructive method of oral and maxillofacial defect with free tissue flaps. METHODS: The clinical materials were collected from 1 973 reconstructive cases between January 2000 and June 2004 and analyzed in terms of the distribution of age, gender, disease type, defect location, reconstructive method and the incidence of vascular crisis of free flaps as well as success rate of free flap respectively. SAS 6. 12 was adopted for statistical analysis. RESULTS: A total of 1973 reconstructive cases includded 764 in middle age (>45 years to < or =60 years, 38.72%), 527 in old age (>60 years, 26.71%), 450 young adults (>28 years to < or =45 years, 22.81%), 187 in young age (>14 years to < or =28 years, 9.48%) and 45 children (< or =14 years, 2.28%). The ratio of male to female was 1.5 : 1. The ratio of benign to malignancy lesion was 1 : 1.94. The tongue defect accounted for 20.63%, followed by mandibular defect(17.38%), parotid defect(13.74%), buccal defect(12.72%), maxillary defect (8.16%), oral pharynx defect (7.60%), floor of mouth defect (5.68%) and others (14.09%). Vascular free flap transfers accounted for 45.82%(904), followed by axial flap(38.17%, 753), random flap (10.19%, 201), avascularized bone graft (1.52%, 30) and others(4.30%, 85). The most frequently used flap was the forearm flap(594 cases), followed by the fibula free flap(143 cases) and the pedicled pectoralis major myocutaneous flap(369 cases); these three flaps accounted for 56.06% (1106/1973). In 47 free tissue flaps (5.20%) having vascular crisis, 30 were saved (63.83%). The success rate of total free tissue flaps was 98.19% (923/940). CONCLUSION: The majority of reconstructive cases of oral and maxillofacial defects is the middle aged and the old aged male patients with malignancy. The tongue defect accounts for about one fifth of all the cases. The vascularized free flap has a high success rate, so it is a main method for reconstruction of oral and maxillofacial defects. The forearm flap, the fibular free flap and the pedicled pectoralis major myocutaneous flap are the main management for repairing oral and maxillofacial defects.