口腔颌面部肿瘤根治同期血管化组织瓣修复术的临床疗效观察*

Clinical observation on treatment of angiochemical tissue flap in oral and maxillofacial tumors*

摘要:

目的 观察和探讨口腔颌面部肿瘤根治同期血管化组织瓣修复术的临床效果。方法 选取2015年8月—2017年2月南京医科大学附属口腔医院64例口腔颌面部肿瘤患者。根据患者病情选择气管插管静脉复合麻醉方法；术中严密观察患者的生命体征，实施综合措施，减少手术时间及出血量；根据不同组织瓣修复术，将其分成股前外侧皮瓣组、小腿内侧皮瓣组、前臂皮瓣组及游离腓骨瓣组，对比各组患者手术治疗效果、术后功能及生存质量情况。结果 患者体内组织瓣的存活率为95.31%（61/64），所有患者在住院治疗期间无死亡发生等恶性事件，顺利出院。麻醉前后经皮血氧饱和度（SpO2）、血压（BP）、平均动脉血压（MAP）及中心静脉压（CVP）比较，差异有统计学意义（P?<0.05），均有不同程度改善。各组血管吻合时间、术后皮瓣危象率及术后皮瓣成活率比较，差异无统计学意义（P?>0.05）；各组患者间吐字发音和咀嚼吞咽功能恢复情况比较，差异无统计学意义（P?>0.05）；各组患者术后总体生存质量评分比较，差异无统计学意义（P?>0.05），各组患者术后均取得较满意效果。结论 口腔额面部肿瘤类型较多，病情复杂，合理适宜且有针对性的血管化组织瓣对口腔颌面部肿瘤修复有显著的临床效果，口腔功能恢复好，提高患者术后生活质量。

Abstract:

Objective To observe and discuss the clinical effect and anesthetic management of neovascularization in oral and maxillofacial region. Methods Sixty-four patients with oral and maxillofacial tumors admitted to our hospital from August 2015 to February 2017 were selected. According to the patients’ condition, the tracheal intubation vein combined anesthesia method was selected; the vital signs of the patient were closely observed during the operation, and comprehensive measures were taken to reduce the operation time and the amount of bleeding; according to different tissue flap repair, it was divided into the anterolateral thigh flap group, the medial flap group, the forearm flap group and the free iliac bone flap group. The surgical treatment effect, postoperative function and quality of life were compared between the groups. Results The survival rate of tissue flaps in the patients participating in the study was 95.31% (61/64). All cases had no malignant events such as death during hospitalization and were discharged successfully. The indexes of SpO2, BP, MAP and CVP were improved to different degrees before and after anesthesia, and the difference was statistically significant (P??0.05). There was no significant difference in the pronunciation between the words and the recovery of chewing and swallowing function between the groups (P?> 0.05). There was no significant difference in the overall quality of life scores between the groups (P?>?0.05). The patients after each group of tissue flaps achieved satisfactory results. Conclusions There are many types of oral frontal and facial tumors, and the condition is complex. Reasonable and suitable vascularized tissue flaps have achieved significant clinical effects on oral and maxillofacial tumor repair. The oral function recovery is good and the quality of postoperative survival is improved. It is worthy of application.