前臂皮瓣修复口腔颌面部软组织缺损75例临床分析

目的总结前臂皮瓣用于口腔颌面部修复的经验,对前臂皮瓣的用途,应用方法,成败因素等加以分析和讨论.方法2001年2月至2004年9月,应用前臂皮瓣游离移植修复口腔颌面部软组织缺损75例,其中,男性50例,女性25例;年龄32～81岁,除一例为其他原因造成的面部软组织缺损外,均为口腔颌面部恶性肿瘤术后组织缺损,常规切取前臂皮瓣并即刻修复缺损;结果75例前臂皮瓣成活73例,修复成功率为97.3%.所有病例均为即刻修复.制取的前臂皮瓣面积最大为10 cm×8 cm,最小为5 cm×3 cm,平均面积为7.5 cm×5.5 cm,血管蒂最长约11cm,平均长度为9 cm.3例出现血管危象,1例抢救成功,2例失败.结论前臂皮瓣游离移植是目前修复口腔颌面部软组织缺损的较理想的选择.口腔恶性肿瘤切除后的修复,尤其是颊癌,应用前臂游离皮瓣移植修复的效果要优于传统的游离皮片移植等修复方法.     

术前TPF诱导化疗在中晚期口腔鳞癌治疗中的初步评估

目的 初步探讨术前TPF诱导化疗方案在口腔中晚期口腔鳞癌治疗中的临床疗效。 方法 2008年6月至2010年6月48例中晚期口腔鳞癌患者接受TPF诱导化疗,化疗方案为D1多西他赛75 mg/m2,D1顺铂75 mg/m2,D1-D5 5-氟尿嘧啶(5-FU)750 mg/m2,以及相关的保护性用药,结束2个周期化疗后2周对疗效进行评价,应用化疗前定点液定点肿瘤边缘或参照CT/MRI影像学治疗前后对比评价效果,分为完全缓解（CR）、部分缓解（PR）、病灶稳定（SD）和疾病进展（PD）,CR+PR计为有效病例。 结果 化疗结束2周后观察到CR 2例,PR 26例,SD 18例,PD 2例,有效率为58.33%（28/48）,化疗期间内未见严重不良反应。 结论 TPF诱导化疗可使中晚期口腔鳞癌瘤体体积明显缩小,近期效果显著,远期疗效有待进一步观察。     

PCR－RDB技术检测中国籍OSCC及OLK患者中的HPV

目的：研究口腔鳞癌（OSCC）及口腔白斑（OLK）中国患者中的人乳头瘤病毒（Human Papillomavirus, HPV）感染率。方法：提取35例OSCC及35例OLK患者病损组织DNA,通过聚合酶链式反应结合反向点杂交技术（Poly－merase Chain Reaction-Reverse Dot Blot Hybridization, PCR-RDB）检测23型HPV DNA,包括HPV6,11,16,18,31,33,35,39,42,43,45,51,52,53,56,58,59,66,68,73,81,82和83。结果：35例OSCC及35例OLK患者中HPV DNA均为阴性。结论：HPV感染在中国的OSCC及OLK患者中非常见分子事件。     

Prognostic significance of dysplasia associated with oral squamous cell carcinoma in patients undergoing surgery with curative intent

The aim of this study was to evaluate the prognostic significance of dysplasia in patients undergoing primary surgery with curative intent in the treatment of oral squamous cell carcinoma (OSCC). This study specifically aimed to demonstrate the effect of dysplasia on local recurrence, disease specific survival (DSS) and overall survival (OS). Data collection for 833 patients with OSCC undergoing treatment for curative intent was undertaken retrospectively for the period of February 2006 to May 2020. Analysis of any association between known clinicopathological prognostic categorical variables with respect to dysplasia was undertaken using the chi squared test. A Kaplan-Meier analysis was performed to demonstrate the impact of dysplasia on DSS and OS, and Cox’s proportional-hazards model deployed to obtain hazard ratios associated with dysplasia and the outcomes of interest. Dysplasia was statistically significant in predicting disease specific and overall survival in patients undergoing primary surgery for OSCC (DSS p<0.001, HR 0.577; 95%CI 0.428 to 0.777), OS p<0.001 HR 0.691; 95%CI 0.562 to 0.850) with the absence of dysplasia predicting poorer outcomes. The absence of dysplasia correlated with pathological higher T and N stage, increased categorised depth of tumour invasion, non-cohesive invasive front, lymphovascular invasion, perineural invasion, extranodal extension and increased modified Glasgow Prognostic Score. No significant prognostic relationship was attributable to the presence of dysplasia at a surgical margin. The absence of dysplasia appeared to be a significant independent prognostic indicator for patients with OSCC. The presence or absence of dysplasia may provide a heuristic means of stratifying OSCC primary lesions in terms of disease hostility.     

游离皮瓣修复口腔颌面部组织缺损106例临床分析

目的:总结游离皮瓣用于口腔颌面部修复的经验。方法:2007-06～2010-06,应用游离组织瓣移植修复口腔颌面部组织缺损106例(前臂皮瓣42例,腹直肌肌皮瓣18例,股前外侧皮瓣46例),患者中男性67例,女性39例,年龄24～77岁,除3例外均为肿瘤切除造成的组织缺损,所有病例均为即刻修复。结果:106例游离组织瓣成活103例,修复成功率为97.2%。制取的皮瓣面积最大为16 cm×8 cm,最小为5 cm×4 cm;4例出现血管危象,2例抢救成功,2例失败。结论:对于口腔颌面部肿瘤切除后形成的组织缺损,游离组织瓣是进行修复的理想选择。     

两种血管吻合方式对游离组织瓣修复口腔颌面部缺损中皮瓣成活的影响

目的比较国产73-Ⅱ型血管套接器与普通血管缝合两种血管吻合方式对游离组织瓣修复口腔颌面部缺损中皮瓣成活的影响。方法根据不同的血管吻合方式将2005年10月至2012年1月间本院63例应用游离组织瓣修复口腔颌面部缺损的患者分为两组,血管套接组（n=32）修复时采用国产73-Ⅱ型血管套接器吻合动脉及静脉,普通血管缝合组（n=31）采用血管缝线吻合血管,比较两组病例血管吻合时间,术后皮瓣危象发生率、皮瓣成活率,以及患者面部外形、面部功能恢复情况。结果血管套接组、普通血管缝合组血管吻合时间分别为（15.66±8.76）分钟、（65.55±15.14）分钟,两组吻合时间有统计学差异（P〈0.05）。两组共移植组织瓣63例,术后发生皮瓣危象3例,成活61例,皮瓣危象发生率4.76%,总成活率为96.83%。血管套接组移植游离组织瓣32例,术后发生皮瓣危象1例、成活31例,皮瓣危象发生率3.13%、成活率96.88%;普通血管缝合组移植游离组织瓣31例,术后发生皮瓣危象2例、成活30例,皮瓣危象发生率6.45%、成活率96.77%。两组术后皮瓣危象发生率、皮瓣成活率均无显著差异（P〉0.05）。所有患者的创口均一期愈合。所有患者面部外形恢复良好、舌体运动、咬合关系及吞咽功能基本正常。结论游离组织瓣移植修复口腔颌面部缺损安全有效,患者面部外形、功能恢复满意。术中血管套接和普通缝合吻合血管的方法,术后皮瓣危象发生率和皮瓣成活率基本相同,但血管套接法吻合速度快、易于掌握,临床上需根据具体病情,结合患者自身经济条件进行选择。     

血管吻合器在游离皮瓣修复口腔颌面部缺损中的应用

目的:探讨血管吻合器在口腔颌面部游离皮瓣血管吻合中的应用效果.方法:2014年9月-2015年5月,对21例患者行口腔颌面部组织缺损游离皮瓣修复创面,供血动脉选用面动脉及甲状腺上动脉,回流静脉选用颈外静脉及颈内静脉分支.手工吻合游离皮瓣动脉18条,吻合器吻合游离皮瓣动脉3条、静脉21条;其中头静脉13条,腓动脉伴行静脉6条,股前外侧动脉伴行静脉2条,观察其吻合时间及吻合血管通畅率.采用SPSS 17.0软件包进行统计学分析.结果:吻合后勒血试验证实,动脉和静脉血流通畅率100％.动脉吻合中,供血动脉选用面动脉16次,甲状腺上动脉5次;回流静脉选用静外静脉13次,颈内静脉分支8次.手工吻合动脉平均时间为(17.20±2.31)min,吻合器动脉吻合平均时间为(5.48±1.33) min;手工吻合静脉平均时间为(18.39±3.48) min,吻合器吻合静脉平均时间为(6.45±0.60) min.术后随访游离皮瓣全部成活,缺损修复后皮瓣颜色、形态及质地良好,未出现皮瓣危象及皮瓣坏死.术后血管彩超均显示吻合后动脉吻合口血流通畅,无血栓形成.术后1～3个月复诊,均未见皮瓣坏死.结论:应用血管吻合器吻合静脉速度快,通畅率高,初步结果证明该血管吻合器安全、有效,在一定程度上可节约手术时间.     

游离组织辦在口腔颌面-头颈肿瘤缺损修复中的应用:2549例临床分析

目的:探讨不同游离组织瓣在口腔颌面-头颈肿瘤缺损与修复中的应用价值。方法:回顾分析1979年1月～2006年12月间,我院口腔颌面外科所行血管化游离组织瓣移植患者2549例,共制备皮瓣2684块:软组织瓣包括前臂皮瓣、背阔肌皮瓣、胸大肌皮瓣、股前外侧皮瓣、肩胛皮瓣等;骨组织瓣包括腓骨肌皮瓣、髂骨肌皮瓣、肩胛骨肌皮瓣等。分别用于修复舌、腭、颊、口底、颌骨及面颈部大面积复合缺损。统计各年代游离组织瓣移植的成功率,分析失败原因。结果:游离组织瓣移植成功率从80年代初期(92%)至今(98.5%),呈逐年升高趋势,2684块皮瓣总成功率达96.80%。前臂皮瓣是最常用的游离组织瓣(64.12%),胸大肌皮瓣和背阔肌皮瓣在修复大面积复合缺损常被采用,各种骨肌(皮)瓣应用于颌骨缺损修复成为近年的热点。大范围复合组织缺损的救治性手术常需要多个游离组织瓣联合修复重建。结论:血管化游离组织瓣移植是口腔颌面-头颈肿瘤手术根治的保障,更是术后缺损修复的主要手段。前臂皮瓣是修复舌、颊、腭等软组织缺损的首选瓣,胸大肌与背阔肌(皮)瓣适合修复体积较大的缺损,腓骨、髂骨肌瓣是上、下颌骨缺损最常用的修复手段。其他不常用的组织瓣,应根据不同适应证进行选择。采用不同组织瓣修复口腔颌面部缺损,对患者术后外形及功能具有重要意义。     

口腔鳞癌中COX-2、VEGF-C的表达及其临床意义

目的：检测口腔鳞癌（OSCC）中COX-2、VEGF-C的表达,以探讨COX-2、VEGF-C与OSCC淋巴转移的关系及其临床意义。方法：应用免疫组织化学染色S-P法检测COX-2、VEGF-C在OSCC中的表达情况。结果：COX-2在OSCC组织中表达明显高于正常口腔黏膜（P〈0.01）;COX-2在伴淋巴结转移者的阳性表达率明显高于不伴淋巴结转移者（P〈0.05）。VEGF-C在OSCC组织中表达明显高于正常口腔黏膜（P〈0.01）;VEGF-C在伴淋巴结转移者的阳性表达率明显高于不伴淋巴结转移者（P〈0.05）。40例OSCC组织中,COX-2与VEGF-C表达共阳性16例（40.0%）,表达阴性10例（25.0%）,二者在OSCC中的表达成正相关（r=0.517,P〈0.01）。结论：COX-2、VEGF-C在OSCC组织中表达明显上调,并与淋巴结转移有关,提示二者有可能在OSCC的生长及转移中起重要作用。COX-2表达上调与VEGF-C表达成正相关,提示二者在OSCC的淋巴管生成及侵袭转移中可能起协同作用。     

Early oral intake after reconstruction with a free flap for cancer of the oral cavity

To allow healing of the surgical wound patients are traditionally given nothing by mouth for 6–12 days after resection and reconstruction of a cancer of the oral cavity. Our aim was to assess the impact of introducing oral intake within 6 days postoperatively. Consecutive patients who had resection and reconstruction of a cancer of the oral cavity with a free flap within an 8-year period were selected from the head and neck database. Personal and social data; type, stage, and site of the tumour; type of resection and free flap; postoperative complications; and duration of hospital stay were recorded, supplemented by review of casenotes for the time that oral intake was started, duration of nasogastric and tracheostomy intubation, and changes in body weight. Patients in the early oral intake group started oral intake within 5 days postoperatively, and those in the late group began feeding from postoperative day 6. The duration of hospital stay in the early group was significantly shorter than that in the late group. There was, however, no difference in the morbidity, including orocutaneous fistula, between the two groups. The duration of nasogastric and tracheostomy intubation was shorter, and weight loss was less, in the early group than in the late group, but not significantly so. Early oral feeding does not increase the morbidity for patients having resection and reconstruction with free flaps for cancers of the oral cavity. Early oral intake is associated with a shorter hospital stay, and this may have implications for improved postoperative outcome.     

Risk factors in securing successful surgical resection of oral squamous cell carcinoma

The purpose of this retrospective study was to analyze the factors that had a significant effect on securing a successful surgical resection (surgical margin) in oral cancer surgery. One hundred forty-eight consecutive patients who underwent planned radical resection of oral squamous cell carcinoma (SCC) were analyzed. Successful resection was judged if pathological examination of the surgical specimen revealed a clear surgical margin (no SCC within 5 mm, n = 116), while an unsuccessful resection was judged if there was a close and involved surgical margin (SCC within 5 mm, n = 21; and SCC at margin, n = 11). Univariate analyses showed that gender, age, and T-classification had significant influence on successful surgical resection. The results of multivariate logistic regression analysis showed that age (odds ratio [OR] = 1.042, 95% CI = 1.001-1.084), T-classification (OR = 1.656, 95% CI = 1.060-2.587), and the presence of preoperative treatment (OR = 2.868, 95% CI = 1.047-7.85) had significant effects on successful surgical resection. The results of this study suggested that successful resection of oral SCC was difficult in patients with either older age or advanced (T4) tumor. It is also suggested that preoperative therapy had a positive effect on securing a pathologically clear surgical margin.     

Sternocleidomastoid myocutaneous flap for intraoral reconstruction after resection of oral squamous cell carcinoma.

PURPOSE: The sternocleidomastoid (SCM) myocutaneous flap remains an important tool in head and neck reconstruction. This article retrospectively reviews 40 consecutive SCM myocutaneous flaps used for the reconstruction after resection of oral squamous cell carcinoma with respect to reliability and complications. PATIENTS: From 1987 to 1997, 40 patients underwent SCM myocutaneous flap reconstruction of the oral cavity. The age and gender of the patients, site of primary tumor TNM stage, type of associated operation, and clinical course were analyzed. RESULTS: In 8 cases, partial epithelial loss over the skin paddle occurred with survival of the muscle and at least some of the dermis. Unilateral supraomohyoid neck dissection (SND) was performed in 11 cases, and unilateral functional neck dissection, which preserves SCM and/or internal jugular vein and/or accessory nerve, in 16 cases. Pathologically positive nodes were recognized in 14 of these 27 neck dissection cases; in 11 of these 14 cases, the neck lesion was controlled. CONCLUSION: The SCM myocutaneous flap appears to be simple to use and useful for reconstruction of the defect after resection of oral carcinoma, and the indications for this flap will be extended in accordance with the recent increases in the number of supraomohyoid and functional neck dissection cases.     

口腔颌面缺损游离组织移植修复138例临床分析

目的探讨影响游离组织移植成功的因素,为各种游离组织瓣在口腔颌面头颈外科的应用提供临床参考。方法收集2005年1月～2008年6月进行游离移植的138例组织瓣,其中前臂皮瓣46例,游离背阔肌瓣10例,股前外侧皮瓣3例,足背皮瓣1例;腓骨肌瓣39例,腓骨肌瓣联合小腿外侧皮瓣36例,髂骨肌瓣3例。修复良性肿瘤术后缺损者41例,恶性肿瘤术后缺损者96例,发育畸形1例。血管吻合采用改良的二定点吻合法。结果 138例游离移植的组织瓣的成功率为99%以上,有1例足背皮瓣在术后7天出现静脉危象,第8天皮瓣坏死。1例腓骨肌瓣联合小腿外侧皮瓣患者手术后12h出现动脉危象,经抢救成活。2例前臂皮瓣和1例腓骨瓣术后24小时内出现静脉危象,经过重新吻合后抢救成功;1例前臂皮瓣在术后第6天出现静脉危象,抢救成功。其它132例游离组织瓣均达到Ⅰ期临床愈合。结论影响游离组织瓣移植成活的因素很多,血管吻合技术以及吻合后血管蒂的摆放是成功的关键。为了防止术后静脉危象的出现,在可能的情况下尽量吻合2根静脉。     

Development of a novel resection and cutting guide for mandibular reconstruction using free fibula flap

Introduction

The authors developed a semi-standardised resection and cutting guide for mandibular reconstruction with free fibula flap based on data of mandible sizes and angles.

股前外侧肌皮瓣修复颊癌术后缺损23例临床分析

目的:探讨股前外侧肌皮瓣修复颊癌术后软组织缺损的效果.方法:2013年5月-2015年5月以股前外侧肌皮瓣修复颊癌术后缺损患者23例.设计并制备股前外侧肌皮瓣单岛或者多岛,修复颊癌术后组织缺损.术后观察口腔颌面部及供区形态和功能,总结皮瓣制取及修复经验.结果:23例股前外侧皮瓣全部成活,其中3例术后24 h内出现血管危象,经抢救后皮瓣成活,成活率100％.随访1～3 a,口腔颌面部及供区形态、功能恢复良好,1例出现颊部积液并感染,经冲洗引流处理后恢复良好;2例术后复发、死亡.结论:股前外侧肌皮瓣修复颊癌术后软组织缺损效果良好,值得临床推广应用.     

口腔黏膜鳞状细胞癌端粒酶活性与PCNA表达的关系

目的 :探索口腔黏膜鳞状细胞癌端粒酶活性与增殖细胞核抗原 (PCNA)表达的关系。方法 :应用TRAP PCR ELISA方法及免疫组化SP法对 68例口腔黏膜鳞状细胞癌组织、3 4例癌旁上皮组织和 12例正常口腔黏膜组织进行检测。结果 :口腔黏膜鳞状细胞癌组织中端粒酶表达阳性率为 67.65 % ( 4 6/ 68) ;癌旁组织中端粒酶表达率为 8.82 % ( 3 / 3 4) ;正常口腔黏膜组织中无端粒酶活性表达。口腔黏膜鳞状细胞癌组织端粒酶活性表达与临床病理分级有关 ;端粒酶活性阳性的 46例癌组织和 3例癌旁上皮异常增生组中PCNA阳性细胞密度为 ( 165 .3 1± 1.82 )个 /mm2 ,端粒酶阴性的 2 2例癌组织和 10例癌旁上皮异常增生组中PCNA阳性细胞密度为 ( 96.77± 1.74)个 /mm2 。端粒酶活性阳性组与阴性组之间PCNA阳性细胞密度差异有统计学意义 (P <0 .0 1)。结论 :端粒酶活性与口腔黏膜鳞状细胞癌发生、发展密切相关 ;端粒酶活性与PCNA阳性表达有关     

应用颏下岛状皮瓣修复24例早期口腔癌术后缺损疗效评价

目的： 评价应用颏下岛状皮瓣修复早期舌、颊、牙龈癌术后组织缺损的疗效。方法： 选择2014年11月—2017年8月收治的24例早期口腔癌患者,其中舌癌16例,牙龈癌5例,颊癌3例。患侧行肩胛舌骨上颈淋巴清扫术后,扩大切除病灶,同期应用3 cm×4 cm～5 cm×7 cm颏下岛状皮瓣修复组织缺损,对皮瓣成活、肿瘤复发、患者生存时间与生存质量进行评价。结果： 23/24例皮瓣成活,成活率为96%。术后随访3～30个月,1例牙龈癌局部复发,复发率为4%;2例舌癌远期颈部淋巴结转移,发生率为8%。患者言语、进食基本正常,对口腔形态及功能比较满意,随访期内未发生死亡病例。结论： 传统带蒂颏下岛状皮瓣制备简单,成活率高,手术创伤小,术后护理容易,是修复早期舌、颊、牙龈癌术后缺损的一种比较安全、可靠的方式。     

Assessment of quality of life and sociocultural aspects in patients with ameloblastoma after immediate mandibular reconstruction with a fibular free flap

Our aim was to evaluate the quality of life (QoL) in patients with ameloblastoma who had been treated by immediate mandibular reconstruction with a fibular free flap, and to analyse the association between QoL and their sociocultural and medical characteristics. We assessed the QoL outcomes of 33/45 patients using the University of Washington quality of life (UW-QoL) questionnaire and the 14-item Oral Health Impact Profile (OHIP-14). Thirty-three of the 45 questionnaires were returned (73%). In the UW-QoL the best-scoring domain was “shoulder”, whereas the lowest scores were for “chewing” and “activity”. In the OHIP-14 the lowest-scoring domain was “handicap”, followed by “social disability” and “psychological discomfort”. Mandibular reconstruction with a fibular free flap significantly influenced the patients’ QoL and oral function. Their sociocultural data showed that most patients had a fairly low level of education.     

人口腔鳞状细胞癌细胞系TSCC2016的建立及生物学特性分析

目的: 建立一株口腔鳞状细胞癌细胞系TSCC2016,明确其生物学特性,为研究口腔鳞状细胞癌的发病机制和临床治疗提供工具。方法: 选取新鲜的口腔鳞状细胞癌患者手术标本,采用组织块培养法,建立口腔鳞状细胞癌细胞系TSCC2016,观察其细胞形态和生长特性,对其表面标记、细胞核型和裸鼠成瘤等进行检测。采用SPSS13.0软件包对数据进行统计学分析。结果: TSCC2016的传代已经超过100代。细胞生长稳定,形态为均一的多角形上皮细胞,具有典型的口腔鳞状细胞癌细胞特点。细胞STR分型结果表明,TSCC2016细胞为原代培养出的口腔鳞状细胞癌细胞,无其他肿瘤细胞系污染。TSCC2016细胞的成瘤性较好,成瘤率为100%,瘤体生长较快。结论: 成功建立了一株口腔鳞状细胞癌细胞系TSCC2016,为口腔鳞状细胞癌的基础研究提供了一个稳定的细胞株。