颌面部肿瘤切除同期皮瓣修复术后防治下肢深静脉血栓形成的临床经验

目的 探讨口腔颌面肿瘤切除同期皮瓣修复术后防治下肢深静脉血栓形成（DVT）的原因及防治措施。方法 回顾性分析2017年1月至2019年11月我院口腔颌面外科行口腔颌面肿瘤切除同期皮瓣修复术的患者1600例，通过下肢多普勒超声检查发现17例下肢深静脉血栓形成患者，分析17例患者年龄、手术时长、术后卧床时长、皮瓣方式等治疗数据，并分析手术前后凝血常规、多普勒超声等检查资料。结果 17例下肢深静脉血栓形成的患者平均年龄63岁，手术时长平均8.09小时，下肢游离皮瓣14例，占DVT患者的82.4%，术后取下肢游离皮瓣者卧床制动5～7天。所有患者皮瓣存活，经治疗后术区无出血及血肿，D-二聚体水平降低，下肢深静脉血栓溶解或附壁，血流通畅。结论 口腔颌面肿瘤切除同期皮瓣修复术患者下肢深静脉血栓形成风险高，应采取积极有效的预防及治疗措施。

The prevention and treatment of deep venous thrombosis after oral and maxillofacial tumor resection and flap reconstruction

Objective To investigate the causes and nursing measures of deep venous thrombosis （DVT） after oral and maxillofacial tumor resection and flap reconstruction. Methods From January 2017 to November 2019, 1600 patients underwent oral and maxillofacial tumor resection and flap reconstruction in our center were retrospectively analyzed. Seventeen patients with deep venous thrombosis were detected in lower extremity by Doppler ultrasound examination. The treatment data of 17 patients, such as age, operation time, postoperative in bed time, kind of flaps, were analyzed. The blood coagulation test and Doppler ultrasound examination were analyzed before and after operation. Results Seventeen patients with deep venous thrombosis with average age of 63 years old. The average operation time was 8.09 hours. There were 14 cases of free flaps from lower limbs, accounting for 82.4% of all DVT patients and these patients were in bed for 5~7 days after the operation. After treatment, there was no flap lost, and no bleeding and hematoma in the operation area. The level of D-dimer was decreased. The deep vein thrombosis of lower extremity was dissolved or attached to the wall, and the blood flow was unobstructed. Conclusion Patients underwent oral and maxillofacial tumors resection and flap reconstruction have high risk of DVT in lower extremities and effective prevention and treatment strategies should be taken.