舌癌根治术后游离前臂皮瓣一期舌再造术的改进

背景与目的：舌癌根治术造成半舌缺损,严重影响患者的生存质量。术中行一期舌再造术可保证手术创面的Ⅰ期愈合,使患者的吞咽及语言功能早日恢复,然而游离皮瓣再造舌时常发生的血管危象问题一直阻碍着这项手术的广泛开展。本文报告在应用游离前臂皮瓣行一期舌再造术中所做的一些改进方法,旨在提高其成功率。方法：对32例舌鳞癌患者在根治术中应用游离前臂皮瓣行一期舌再造,在皮瓣设计、制备和血管吻合等方面加以改进。结果：术后口腔和颈部创面均一期愈合,无涎瘘、乳糜漏、口底颌下瘘和感染等并发症发生;术后出现血管危象6例,5例抢救成功,1例失败,最终放弃皮瓣,移植成活率为96．9％。再造舌外形大部分良好,语言和吞咽功能恢复良好。结论：改进的游离前臂皮瓣舌再造术再造舌的成功率较高。

Modification for primary tongue reconstruction with free forearm flap after radical operation of tongue carcinoma

BACKGROUND &OBJECTIVE: Radical operation of tongue carcinoma causes hemi-tongue defective, which seriously affected the quality of life in these p atients. The primary tongue reconstruction guaranteed the healing of the surgica l incision at early stage. This may help to recover swallowing and speaking of t he patients. However, the vascular crisis happened in the free flap proved to be an obstacle to the extensive application in the tongue reconstruction. This pap er illustrated some modifications in the application of the free forearm flap, w hich may ensure the success in operation. METHODS: Some methods like skin flap d esign, preparation and vascular anastomosis were modified in the application amo ng the 32 tongue carcinoma patients. RESULTS: The surgical incisions of the oral cavity and neck healed up, with no salivary fistula, chylorrhea, submandibular fistula, infection and other complications. After the operations, 6 flaps develo ped vascular crisis, and 5 flaps were successfully salvaged, meanwhile, one case failed, which resulted in the flap abandonment. The total successful transplant ation rate reached 96.9%. The reconstructed tongue recovered, and the speaking as well as swallowing functions re-obtained. CONCLUSION: The modified methods o f tongue reconstruction with free forearm flap improve the clinical effects of r econstructed tongue.