血清生化因素与口腔颌面部游离组织瓣血管危象的相关分析

目的：探讨血清生化因素在游离组织瓣修复口腔颌面部缺损中对皮瓣成活的影响。方法：回顾分析广西医科大学附属口腔医院2002年1月—2014年4月游离组织瓣修复口腔颌面部缺损的患者799例，其中发生皮瓣血管危象64例，抢救成功43例，失败21例。从735例未发生皮瓣危象患者中随机分层抽取66例患者作为对照组。采集2组患者术前白蛋白、球蛋白、总蛋白、前白蛋白、纤维蛋白原，凝血酶原时间（PT）等生化指标。采用SPSS 16.0软件包对数据进行统计学分析。结果：统计学分析显示，行游离移植皮瓣后血管危象组白蛋白显著低于对照组，而血管危象组纤维蛋白原显著高于对照组（P<0.05）。Logistic 回归单因素分析结果显示，纤维蛋白原是皮瓣发生血管危象的危险因素（P<0.05）。结论：术前纤维蛋白原升高可能与口腔颌面部缺损游离皮瓣移植后发生皮瓣危象有关。

Correlation of serum biochemical factors and vascular crisis of free flap for reconstruction of oral and maxillofacial defect

PURPOSE: To investigate the effects of serum biochemical factors on the vascular crisis of free flaps for reconstruction of oral and maxillofacial defects. METHODS: The medical records of patients who underwent free flap transplantation for oral and maxillofacial reconstruction between January 2002 and April 2014 at the Stomatological Hospital Affiliated to Guangxi Medical University were reviewed. Of the 799 patients who had free flap reconstruction, 64 free flaps had crisis, 43 were salvaged successfully and 21 were lost.　Ｓｉｘｔｙ－ｓｉｘ patients from 735 patients without crisis of free flap were selected as control group. Preoperative routine serum biochemical parameters including albumin, globin, prealbumin, fibrinogen and PT etc, were collected and analyzed with SPSS 16.0 software package. RESULTS: The results of student's t test showed that albumin in the vascular crisis group was significantly lower than that in the control group after receiving free flap transplantation.　However, fibrinogen in vascular crisis group was significantly higher than that in control group(P<0.05).　Logistic regression analysis showed that fibrinogen was a risk factor for flap vascular crisis (P<0.05). CONCLUSIONS: Increased fibrinogen in pre operative serum may raise the risk of vascular crisis of free flap for oral and maxillofacial reconstruction.