口腔口咽肿瘤切除术后较大缺损修复的研究

目的总结口腔口咽肿瘤切除后较大缺损的修复方法，讨论影响组织瓣相关并发症的因素。方法回顾性分析2004年12月～2006年4月我院头颈外科收治的部分口腔口咽肿瘤患者64例，肿瘤切除后出现较大缺损，使用组织瓣66块进行修复，其中带蒂组织瓣39块，游离组织瓣27块。结果27例游离组织瓣中，2例前臂皮瓣坏死，成功率92．6％；39例带蒂组织瓣中，4例胸大肌肌皮瓣出现部分坏死。成功率90％。64例患者中，除1例死亡外，全部恢复经口进食。带蒂或游离组织瓣的选择及术前放疗与否不影响组织瓣相关并发症的发生。结论对口腔口咽部肿瘤切除后的较大缺损，应视缺损的范围、大小及患者的一般情况、术前放疗、颈部手术史等综合考虑，选择最合适的组织瓣进行修复。如果出现皮瓣相关井发症，尤其对术前放疗者应积极处理。

Reconstruction for large defect after ablation of tumor in oral cavity or oral pharynx

Objective To review the reconstruction for large defect after ablation of tumor in oral cavity or oral pharynx,and analyse the factors which effect the flap-related complications. Methods From December 2004 to April 2006,64 patients with cancers in oral cavity or oral pharynx were treated in our surgery department. After ablation of tumors,66 flaps were used to reconstruct the defect, which included 39 pedicled and 27 free flaps. Results 2 free radial forearm flaps occurred failure, and success rate in free flaps was 92.6%. 4 pectoralis major pedicled flaps occurred partial failure,and success rate in pedicled flaps was 90%. Of the 64 patients,one died from carotid artery bleeding after flap failure, which got radiotherapy before surgery, and all the others recovered oral diet. Statistic analysis suggested that the choice of pedicled or free flaps and pre-operative radiotherapy had no certain relations with the occurrence of flap-related complications. Conclusion For large defects after ablation of tumors in oral cavity or oral pharynx,reconstruction with suitable flaps should be used. The choice of pedicled or free flap depended on the size and the extension of defect, history of surgery in neck or preoperative radiotherapy, and general status of the patient. After indications of flap failure occurred, emergent management should be done to salvage the flap, especially for those who got preoperative radiotherapy.