全舌口底喉切除和双侧颈清同期口咽腔重建术

以往舌根部晚期恶性肿瘤或舌癌多次复发后己侵及喉的处理,时常是临床医生最为棘手和困难的问题。由于缺乏有效修复手段,常被认为是手术禁忌。单纯放疗和化疗多不能有效地控制。自从70年代末及80年代初以来应用各类肌皮瓣及游离皮瓣立即修复口腔恶性肿瘤切除术后缺损的经验日趋丰富,对于舌根部癌瘤及舌癌复发己侵及喉的患者已有了手术及其综     

面动脉瓣修复口咽癌术后缺损

目的探讨面动脉瓣修复口咽癌术后缺损的效果及临床应用。 方法选择2008年5月至2014年1月中山大学孙逸仙纪念医院口腔颌面外科收治的口咽癌患者33例,行肿瘤扩大切除术同期采用顺行或逆行面动脉瓣修复组织缺损。 结果33例面动脉瓣中,逆行性皮瓣11例全部成活,而顺行性皮瓣成活18例、部分坏死2例、完全坏死2例。皮瓣成活病例伤口愈合良好,患者术后语音和吞咽功能得到恢复。 结论应用面动脉岛状肌皮瓣修复口咽癌切除术后缺损,制取技术简单,皮瓣血供明确,皮瓣成活率高,瘢痕较为隐蔽,是修复口咽癌切除术后缺损的理想皮瓣。     

舌—口底大部或全部缺损立即采用肌皮瓣的修复

<正> 舌、口底为口腔恶性肿瘤常见发病部位,且极易向邻近区域侵犯,术后缺损所引起语言、吞咽的严重功能障碍众所周知,为恢复这类病员的功能和外形,舌的再造成了口腔颌面外科医师历来探讨的一个课题。我科自1981年以来,采用大块胸大肌肌皮瓣和背阔肌肌皮瓣进行整复,取得了满意的效果,现报道如下。     

口底皮样囊肿伴舌瘘1例

口底皮样囊肿比较常见,但伴有舌瘘者少见。本文报道1例口底皮样囊肿伴舌瘘的病例,并复习相关文献对其诊断、治疗及发生原因进行探讨。     

颌面外伤致口底蜂窝织炎合并咽瘘1例

<正> 口底蜂窝织炎合并咽瘘者少见,现将我科收治1例报告如下。 患者,男,20岁,因酒后摔伤颌面部16 h,左面部裂伤,口底肿胀,影响进食、呼吸,于2002年2月26日入院。 查体:患者发育正常,神志清,痛苦貌,语音不清,自动体位,体温37.8℃,心率85次/min,呼吸28次/min,血压16.0/9.7 kPa(120/74 mmHg),心肺(-),肝脾未及,四肢活动自如,神经系统无阳性体征。专科检查:左面部、口底明显肿胀,左面部有长约6.0 cm软组织裂伤,深达骨面,创面有大量泥沙     

颈阔肌肌皮瓣修复口咽颌面缺损的评价

本文报告了应用颈阔肌肌蒂皮瓣修复口咽颌面部缺损２８例的临床经验体会。口腔癌占６４．４％，咽部癌占１７．８％，其它占１７．８％。Ｔ１１２％，Ｔ２２２％，Ｔ３３９％，Ｔ４２７％。原发灶切除立即修复网时颈淋巴清扫，常规结扎面动脉１２例占４６．１％，并发症为１０．７％。文中介绍了颈阔肌皮瓣的设计、手术方法。结合临床对此瓣的应用价值及结扎面动脉对皮瓣血运的影响加以评价。     

带蒂胸大肌皮瓣修复老年口底癌术后组织缺损中的应用

目的:分析带蒂的胸大肌皮瓣在老年口底癌术后组织缺损修复中的临床效果.方法:选择我院2010年1月至2019年1月收治的口底鳞状细胞癌患者19例,术中采用带蒂的胸大肌皮瓣转移修复术后组织缺损,术后定期随访,观察皮瓣成活情况及术后恢复情况.结果:随访18～72个月,19例患者中1例患者皮瓣坏死,其余18例患者皮瓣成活,愈合...     

以颈横动静脉为蒂的延长锁骨上岛状瓣折叠修复口咽瘘

目的:观察以颈横动静脉为蒂的延长锁骨上岛状瓣折叠修复口咽瘘的临床效果.方法:利用以颈横动静脉为蒂的延长锁骨上岛状瓣修复11例口咽癌切除术后出现口咽瘘的患者,评价修复效果.11例患者包括8例男性,3例女性.口咽部瘘口大小3.0 cm×1.5 cm～4.0 cm×2.0 cm,颈部皮肤瘘口10 cm×6 cm～12 cm ×7 cm.结果:11例皮瓣全部成活,无严重并发症.术后随访6～18个月,患者吞咽和言语功能恢复正常,无瘘管复发和咽腔狭窄.患者对术后外形满意.结论:以颈横动静脉为蒂的延长锁骨上岛状瓣是修复口咽瘘有效和安全的方法.     

舌正中岛状瓣修复口底缺损

目的：总结应用舌正中岛状瓣修复口底缺损的经验。方法：5例中小型口底缺损患者采用舌正中岛状瓣修复重建。在舌背正中部位制备舌肌黏膜瓣,通过切开舌尖或舌组织隧道以岛状瓣的方式转移修复口底缺损。结果：5例患者术后舌瓣均成活良好,无舌瓣坏死,1例术后一侧舌尖部分坏死。术后随访3-6个月,患者发音及吞咽功能无明显异常。结论：舌正中岛状瓣是一种修复中小型口底缺损的好方法。     

颏下岛状皮瓣在口咽癌术后缺损修复中的应用

目的:探讨颏下岛状皮瓣修复口咽癌术后缺损的临床效果,为临床应用提供经验。方法:选择口咽癌患者13例,其中鳞状细胞癌12例,肌上皮癌1例,行原发灶切除术及颈淋巴清扫术,采用颏下岛状皮瓣修复术后缺损。结果:13例患者中,12例皮瓣全部成活,1例皮瓣远心端坏死,经修剪换药后愈合,术后随访3个月～3 a,未见原发灶复发及颈部淋巴结转移,均获得良好的进食、语言功能。结论:颏下岛状皮瓣毗邻口咽区,供区位于颈淋巴清扫切口线,操作简单、方便。口咽癌I区淋巴结转移较少,用于修复口咽术后中小组织缺损安全有效,具有良好的临床应用价值。     

An analysis of unplanned readmissions after head and neck microvascular reconstructive surgery

The 30-day readmission rate is a highly scrutinized metric of quality surgical care, because readmission is costly and perceived to be avoidable with planning and patient education. Head and neck surgery patients generally have multiple risk factors for readmission, as readmitted patients are generally older, with more co-morbidities, lower socio-economic status, and a history of multiple emergency department visits and readmissions. A retrospective cohort study was implemented to determine the incidence and etiology of 30-day readmission after microvascular head and neck reconstructive surgery, focusing on social risk factors. Data were analyzed by χ² test, analysis of variance, t-test, and logistic regression, with statistical significance set at P < 0.05. Of 209 patients included in this study, 35 (16.7%) had a 30-day readmission. Increased needs at discharge were associated with increased readmission, while other social risk factors were less significant for a readmission in this study.     

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。     

Autologous dermis-fat grafts in head and neck patients: Indications and evaluation in reconstructive surgery

Purpose

The aim of this study was to examine the indications and results of autologous dermis-fat grafts in the reconstruction of maxillofacial soft-tissue defects.

238例头颈肿瘤患者重建术后谵妄危险因素分析

目的 探讨头颈肿瘤患者重建术后谵妄发病的相关危险因素。方法 选择2018年10月—2019年10月于上海交通大学医学院附属第九人民医院接受头颈肿瘤术后重建患者238例,其中男160例,女78例;年龄16~85岁,平均（56.52±15.31）岁。依据《谵妄评估量表》结果,将患者分为谵妄组和非谵妄组,采用SPSS 17.0软件包分析患者术后谵妄的发病率和相关危险因素。结果 头颈肿瘤重建术后谵妄发病率为10.1%（24/238）。组间单因素分析发现,高龄、高血压、既往谵妄、术前睡眠紊乱、术后睡眠紊乱、术中输血、术后疼痛差异有统计学意义（P<0.05）;多因素Logistic回归分析发现,高龄（OR=1.090）、术后睡眠紊乱（OR=15.248）、术中输血（OR=1.003）、术后疼痛（OR=1.398）是患者术后发生谵妄的独立危险因素。结论 头颈肿瘤重建术后高龄、术中输血、术后睡眠紊乱和术后疼痛是谵妄发病的高危因素,应采取一定的预防措施,减少术后谵妄的发生。     

头颈部心外横纹肌瘤

横纹肌瘤是罕见的来源于横纹肌的良性肿瘤,按其发生部位分为心脏横纹肌瘤与心外横纹肌瘤.心外横纹肌瘤90%发生在头颈部.根据肿瘤细胞的分化程度,心外横纹肌瘤分为成人型横纹肌瘤、胎儿型横纹肌瘤与生殖器型横纹肌瘤.头颈部心外横纹肌瘤在临床上主要表现为缓慢生长的无痛性包块,包块呈单发或多发,病程可达数年.组织学检查是诊断横纹肌瘤的主要方法,胞浆中的横纹结构与肌源性蛋白的特殊染色是诊断横纹肌瘤的主要依据.手术切除是治疗头颈部心外横纹肌瘤的有效方法.     

Postoperative bleeding risk for cutaneous surgery in the head and neck region with continued phenprocoumon therapy

In a total of 171 surgical procedures for lesions in the head and neck region in patients in whom phenprocoumon therapy was not stopped, 16 (9%) postoperative bleeding events were observed over a follow-up period of two weeks. Local measures were sufficient in all cases except one severe case where blood transfusion was needed and anticoagulant treatment was stopped for 7 days. The bleeding risk was significantly higher for the surgical procedures of the nose than those in other areas (21% versus 6%, P = 0.014), but was not influenced by the international normalized ratio (INR) of blood coagulation, size, site and type of the lesion, surgical procedure, and sex and age of the patients. The bleeding rate in patients not on any anticoagulation therapy was significantly lower (6/211 = 3%). Across both groups, just over 80% of the bleeding episodes were within the first two days (55% on the same day and 32% on the next day) of the surgery. No bleeding was recorded after 5 days. Our data suggest that cutaneous surgery in the head and neck region can be safely performed with continued phenprocoumon therapy in most cases in an INR range of 1.3–3.4, but rarely severe bleeding does occur and can be managed with a close-contact follow-up and with 24-h on call services during the first two days postoperatively.     

Analysis of tracheostomy-associated morbidity after operations for head and neck cancer

Tracheostomy is a safe and effective way of securing the airway in patients who have radical resections for head and neck cancer. We audited the morbidity after 265 tracheostomies to identify the risks in relation to head and neck surgery, and to propose recommendations to improve care.Twenty-one tracheostomy-related complications were encountered in 256 patients (8%). Most complications occurred during the early postoperative period (72%). There were no tracheostomy-related deaths.Tracheostomies were retained for a median of 10 days (range 1-160). Delayed extubation was associated with extent of resection [P = 0.006], site of tumour (floor of mouth and anterior two thirds of tongue [P = 0.02]), and age (<61 years [P = 0.02]).Patients who were given preoperative radiotherapy were significantly more likely to develop a tracheostomy-related complication (P = 0.03). Patients with a tracheostomy complication were more likely to have other serious complications (P = 0.05) and in these patients there was a risk of delayed extubation (P = 0.06). We conclude that elective tracheostomy is essentially event-free, and most complications occur in the ward.     

Need for intensive care after operations for head and neck cancer surgery

We compared the postoperative morbidity of 44 patients who had had major head and neck oncological resections and who were nursed postoperatively on a general ward with that of 33 who were nursed on an intensive care unit at North Manchester General Hospital and Withington Hospital, South Manchester, respectively. There was no difference in the general morbidity (9/44, 20% compared with 9/33, 27%, 95%, CI of difference -0.26 to 0.13). We conclude that it is safe to nurse the patients on a general ward provided that certain conditions are fulfilled.