21例儿童头颈部恶性肿瘤患者游离皮瓣修复临床分析

目的: 分析儿童头颈部肿瘤患者术区缺损游离皮瓣修复重建的临床特点。方法: 回顾2009—2011年于上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科接受头颈部恶性肿瘤切除以及游离皮瓣修复、年龄≤14岁患者的临床、病理及影像学资料。采用SPSS 17.0软件包对收集的数据进行统计学分析。结果: 最终纳入患者21例,其中男14例,女7例;17例为ASA Ⅰ级,4例为ASA Ⅱ级。中位手术时间480 min,中位术中出血量500 mL。6例患者接受气管切开。发生内科并发症7例,包括肺部感染4例,腹泻3例;外科并发症4例,包括皮瓣下血肿1例,创面裂开2例,腺瘘1例。气管切开术与内科并发症发生直接相关（P=0.035）,与总体并发症（P=0.064）发生具有潜在关联。结论: 游离皮瓣对于儿童头颈恶性肿瘤患者术区缺损修复具有极高价值,术后并发症是影响此类患者预后的主要负面因素,气管切开与术后并发症发生关系较大,需谨慎使用。

Free flap reconstruction in 21 pediatric patients with head and neck cancer: clinical considerations for comprehensive care

PURPOSE: To analyze the clinical characteristics for free flap reconstruction of defects caused by head and neck cancer among patients aged 14 and below. METHODS: A retrospective study was performed in patients who were treated in the Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital from 2009 to 2011, all patients were aged 14 years and below and had reconstructions with free flap for head and neck cancer. Clinical, pathological records and image data were collected and analyzed. SPSS 17.0 software package was used for statistical analysis. RESULTS: Twenty-one patients were finally selected, 14 were male and 7 were female; 17 patients had ASA score grade Ⅰ and 4 patients had ASA score grade Ⅱ. The median operating time was 480 minutes, and median blood loss was 500 mL. Six patients had tracheotomy, 7 had medical complications (4 pulmonary infection, 3 diarrhea), 4 had surgical complications (1 hematoma beneath flap, 2 wound dihescence, 1 salivary fistula). Tracheotomy was related to medical complications(P=0.035) and overall complications (P=0.064). CONCLUSIONS: Free flap reconstruction could be applied in pediatric HNC patients. Postoperative complications were main negative factor for prognosis. Tracheotomy had relationship with postoperative complications and should be cautiously used.