不同修复方法修复口腔颌面部肿瘤术后缺损的效果比较

目的探讨不同修复方法修复口腔颌面部肿瘤术后缺损的效果。方法选取口腔颌面部肿瘤根治术后缺损患者89例,根据最终选取的修复方案分为A组(n=49)和B组(n=40),A组给予股前外侧嵌合皮瓣修复,B组给予串联皮瓣修复。观察2组手术情况,采用华盛顿大学头颈肿瘤生活质量量表(UW-QOL)对患者术后生活质量进行评价,检测唾液中唾液酸(SA)及癌胚抗原(CEA)水平。结果A组手术时间、胃管拔除时间和经口进食时间分别为(6.30±1.19)h、(19.77±2.81)d和(20.32±2.19)d,明显少于B组(P<0.05);但A组皮瓣制作时间为(1.20±0.28)h,明显多于B组(P<0.05)。A组术后6个月UW-QOL量表中外观、吞咽、咀嚼、言语、肩功能、情绪评分分别为(63.29±4.54)分、(54.93±5.03)分、(47.12±6.02)分、(64.49±4.33)分、(82.20±5.43)分和(75.50±7.20)分,明显高于B组(P<0.05)。A组和B组术后6个月UW-QOL量表中疼痛、活动、娱乐、味觉、唾液及焦虑评分比较差异无统计学意义(P>0.05)。A组修复后1个月唾液中SA和CEA分别为(7.29±1.33)ng/dl和(50.04±16.62)ng/ml,明显低于B组(P<0.05)。A组血管危险发生率为2.04%,明显低于B组(P<0.05)。A组和B组感染、皮瓣坏死发生率差异比较无统计学意义(P>0.05)。结论相比较串联皮瓣修复,股前外侧嵌合皮瓣修复口腔颌面部肿瘤根治术后缺损有较好的效果,可以改善患者生活质量。

Comparison of Different Repair Methods for Oral and Maxillofacial Defects afterTumor Surgery

Objective To investigate the effect of different repair methods on oral and maxillofacial defects after tumor surgery.Methods 89 patients with oral and maxillofacial defects after radical tumor resection were selected,according to the final repair plan,they were divided into group A(n=49)and group B(n=40),group A was treated with anterolateral thigh chimeric flap,group B was treated with series flap,the operation conditions of the 2 groups were observed,the quality of life was evaluated by the University of Washington head and neck cancer quality of life scale(UW-QOL),the levels of sialic acid(SA)and carcinoembryonic antigen(CEA)in saliva were detected.Results The operation time,gastric tube extubation time and oral feeding time in group A were(6.30±1.19)h,(19.77±2.81)d and(20.32±2.19)d,which were significantly less than those in group B(P<0.05),while the time for making skin flap of group A was(1.20±0.28)h,which was significantly more than that in group B(P<0.05);The appearance,swallowing,chewing,speech,shoulder function and mood scores in the UW-QOL scaleof group A at6 months after surgerywere(63.29±4.54)points,(54.93±5.03)points,(47.12±6.02)points,(64.49±4.33)points,(82.20±5.43)points and(75.50±7.20)points,which were significantly higher than group B(P<0.05);There were no statistically significant differences in pain,activity,entertainment,taste,saliva and anxiety scores in the UW-QOL scale at 6 months after surgery between group A and group B(P>0.05);1 month after repair,the SA and CEA in saliva of group A were(7.29±1.33)ng/dl and(50.04±16.62)ng/ml,which were significantly lower than those in group B(P<0.05);The incidence of vascular risk in group A was 2.04%,which was significantly lower than that in group B(P<0.05);There was no significant difference in the incidence of infection and flap necrosis between group A and group B(P>0.05).Conclusion Compared with the series flap repair,the anterolateral thigh chimeric flap has a better effect in repairing the defects after radical resection of oral and maxillofacial tumors,and can improve the quality of life of patients.