游离皮瓣移植术对口腔颌面部肿瘤切除术后缺损的修复研究

目的：探讨采取游离皮瓣移植术对口腔颌面恶性肿瘤切除术后组织缺损的修复疗效及其对血清唾液酸（SA）和白介素-2（IL-2）的影响。方法对45例口腔颌面部肿瘤患者，肿瘤切除术后分别采取游离组织皮瓣移植术修复治疗。观察术后皮瓣生长、伤口愈合和不良反应发生情况；随访术后患者复发、吞咽和张口功能恢复以及生存情况；检测血清SA和IL-2水平。结果43例缺损成功修复，成功率95．56％；术后4例因淤血发生皮瓣小面积坏死，3例发生血管危象，经抗炎治疗及局部处理后愈合；1例术后出现供区感染伴积液，给予切开引流后愈合；2例术后2d出现轻度的消化系统不良反应，如恶心、呕吐，导致皮瓣血管危象，行移植皮瓣切除术；局部血肿3例，给予清创止血处理皮瓣愈合。随访时间2～4年，3年生存37例，生存率为82．22％。治疗前，口腔恶性肿瘤患者血清SA水平明显高于对照组和良性肿瘤组，而IL-2水平明显低于对照组和良性肿瘤组，比较差异均有统计学意义（P＜0．01）；治疗后1天和2周，患者血清SA水平均明显下降，而IL-2均明显升高，比较差异均有统计学意义（ P＜0．01）。结论应用游离皮瓣移植术修复口腔颌面恶件肿瘤术后组织缺损疗效好、并发症较少，患者血清SA和IL-2水平测定对口腔颌面部肿瘤术后患者的恢复和预后评价均有重要的临床意义。

Repair Research of Free Skin Flap Grafting on Coloboma after Resection of Benign Oral and Maxillofacial Tumor

Objective To investigate clinical efficacy of free skin flap grafting on coloboma after resection of oral and maxillofacial tumor and its effect on serum levels of sialic acid ( SA) and interleukin ( IL)-2.Methods 45 cases with oral and maxillofacial tumor were selected .All cases were treated by free skin flap grafting after resection of benign oral and maxillofacial tumor.Skin growth,wound healing,and untoward effect were observed after operation .Recidivation,swallow and rictus function, and survival were followed-up after operation .Serum levels of SA and IL-2 were detected .Results 43 cases were successfully re-paired(95.56%).After operation,skin flaps of 4 cases was small area necrosis with extravasated blood and 3 cases had vascu-larcrisis,which were healed by anti-inflammatory treatment and local manage .1 case with area of infection and effusion was healed by incision and drainage .After operation ,2 cases with untoward effect of alimentary system lead to vascularcrisis of skin graft , which were deal with resection of skin graft .3 cases were local hematoma that were healed by debridement and hemostasis .Follow-up was for 2~4 years,and survival rate was 85.53%.Before treatment,serum level of SA in all cases with oral and maxillofacial tumor was obviously higher than the control group and benign tumor group while IL -2 was lower ,there had statistical difference ( P<0.01).Serum level of SA was decreased 1 day and 2 weeks after operation while IL-2 obviously increased(P<0.01).Conclu-sion Clinical efficacy of free skin flap grafting on repairing coloboma following resection of oral and maxillofacial tumor is effec -tive with less complications ,and serum levels of SA and IL-2 are essential for evaluation of recovery and prognosis of oral and maxillofacial tumor .