颈阔肌皮瓣在口底癌手术中的应用(1)
[摘要] 目的 探讨颈阔肌皮瓣修复口底癌术后缺损的可行性。 方法 收集我科自2008年3月~2013年3月收治的12例口底癌患者,12例患者均进行颈阔肌皮瓣的转移修复;另收集同期12例应用其他皮瓣进行修复的患者。其分为两组:Ⅰ组应用颈阔肌皮瓣,Ⅱ组应用其他皮瓣。对两组患者相关数据进行统计学分析。 结果 颈阔肌皮瓣与其他皮瓣相比坏死率、肿瘤术后复发率无明显差异(P>0.05)。术后总引流量、撤引流时间以及拆线时间均少于应用其他皮瓣者(P<0.05)。 结论 颈阔肌皮瓣在修复口底癌术后缺损中是一种很好的选择。
[关键词] 颈阔肌皮瓣;口底癌;组织缺损;修复
[中图分类号] R739.81 [文献标识码] B [文章编号] 1673-9701(2015)30-0051-04
The use of platsma myocutaneous flap in the surgery of the mouth floor carcimoma
CAI Yue1 TAN Xuexin2 TONG Shuang2 HU Yuqian3 ZHANG Renru1 LIU Yu1
1.Department of Stomatology, Huludao Central Hospital in Liaoning Province, Huludao 125001, China; 2.Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, China Medical University, Shenyang 110002, China; 3.The Oral Medicine, the Medical School of Liaodong College, Dandong 118000, China
[Abstract] Objective To find out the feasibility of the platysma myocutaneous flap for repairing the postoperative defect of the mouth floor carcinoma. Methods From March 2008 to March 2013, twelve cases of the mouth floor carcinoma patients in our department were involved, 12 patients were used of the transfer of the platysma myocutaneous flap;12 patients with other flaps were also involved, at the same time, they were divided into two groups, the platysma myocutaneous flaps were used in group Ⅰ,the other flaps were used in group Ⅱ. The related datas of the two groups were analyzed statistically. Results There were no significant differences in the necrosis and recurrence between the platysma myocutaneous flaps and the other flaps (P>0.05). The total postoperative drainage volume, the time of withdrawal drainage and clearing were less than the other flaps(P<0.05). Conclusion The platysma myocutaneous flap is a good choice for the repairment of the mouth floor carcinoma postoperative defect.
[Key words] Platysma myocutaneous flap;Mouth floor carcinoma;Tissue defect;Repair
口底癌作为一种原发于口底黏膜的癌,其发病率相对较低,目前权威机构统计约在口腔癌中居第六位[1]。口底癌可发生于一侧或双侧口底,病理学诊断多为中度分化的鳞状细胞癌。口底癌早期表现为较大的长期不愈合溃疡样病损,之后逐渐发生口底肌群的侵犯并常伴发疼痛。口底癌发展较快,可累及邻近组织,也可能穿过肌层进入颏下及下颌下区。口底癌常较早出现淋巴结转移,一般先转移至颏下、下颌下淋巴结,以后转移到颈深淋巴结,并常发生双侧颈淋巴结转移[2]。口底癌的治疗仍首选手术治疗,临床常行口底、下颌骨、颈淋巴联合根治术。对双侧颈淋巴结转移的患者,可同时或分期行颈淋巴清扫术。对于口底癌病灶切除后引起的组织缺损,常根据缺损的大小选择不同的组织瓣进行修复。颈阔肌皮瓣在临床上是一种较好的选择[3]。但颈阔肌皮瓣在修复口底癌的术后缺损中,存在一定的局限性并有着较多的技术细节要求,本次研究意在探讨颈阔皮瓣用于口底癌术后缺损修复的可行性。现报道如下。
1 对象与方法
1.1 研究对象
本次研究首先收集了我科自2008年3月~2013年3月收治的12例应用颈阔肌皮瓣进行修复的口底癌患者进行回顾性分析,其中男10例,女2例。患者年龄最大67岁,最小51岁,平均年龄(61.0±8.0)岁。肿瘤分期T1期3例,T2期7例,T3期2例(表1),其中2例患者术后病理证实出现单侧颌下淋巴结转移(N1期),所有患者均未发生远端转移,即M0期。肿瘤TNM分期是以口腔癌和口咽癌的国际抗癌联盟(UICC)2010年的分期标准进行。具体为:T1:肿瘤最大直径≤2 cm;T2:肿瘤最大直径>2 cm,≤4 cm;T3:肿瘤最大直径>4 cm。N0:无淋巴结转移;N1:同侧单个淋巴结转移,直径≤3 cm。M0:无远处转移[4]。患者诊断的标准全部根据术中及术后病理结果回报,均为鳞状细胞癌,其中高分化5例,中分化7例。上述患者均于术前签属知情同意书。手术由我科同一资深术者完成。另收集同一时期口底癌进行的其他皮瓣修复的患者12例,男9例,女3例,平均年龄(62.1±7.6)岁,其中前臂瓣6例,胸大肌4例,股前外侧皮瓣2例。纳入标准除未应用颈阔肌皮瓣以外与上述相同。以上24例患者均进行术后2年以上的随访。将应用颈阔肌皮瓣的12例患者设为Ⅰ组,未应用颈阔肌皮瓣而应用其他皮瓣的12例患者设为Ⅱ组。两组患者的性别、年龄及TNM分期比较差异无统计学意义(P>0.05),具有可比性,见表1。, 百拇医药(才越 谭学新 佟爽 胡玉乾 张仁儒 )
[关键词] 颈阔肌皮瓣;口底癌;组织缺损;修复
[中图分类号] R739.81 [文献标识码] B [文章编号] 1673-9701(2015)30-0051-04
The use of platsma myocutaneous flap in the surgery of the mouth floor carcimoma
CAI Yue1 TAN Xuexin2 TONG Shuang2 HU Yuqian3 ZHANG Renru1 LIU Yu1
1.Department of Stomatology, Huludao Central Hospital in Liaoning Province, Huludao 125001, China; 2.Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, China Medical University, Shenyang 110002, China; 3.The Oral Medicine, the Medical School of Liaodong College, Dandong 118000, China
[Abstract] Objective To find out the feasibility of the platysma myocutaneous flap for repairing the postoperative defect of the mouth floor carcinoma. Methods From March 2008 to March 2013, twelve cases of the mouth floor carcinoma patients in our department were involved, 12 patients were used of the transfer of the platysma myocutaneous flap;12 patients with other flaps were also involved, at the same time, they were divided into two groups, the platysma myocutaneous flaps were used in group Ⅰ,the other flaps were used in group Ⅱ. The related datas of the two groups were analyzed statistically. Results There were no significant differences in the necrosis and recurrence between the platysma myocutaneous flaps and the other flaps (P>0.05). The total postoperative drainage volume, the time of withdrawal drainage and clearing were less than the other flaps(P<0.05). Conclusion The platysma myocutaneous flap is a good choice for the repairment of the mouth floor carcinoma postoperative defect.
[Key words] Platysma myocutaneous flap;Mouth floor carcinoma;Tissue defect;Repair
口底癌作为一种原发于口底黏膜的癌,其发病率相对较低,目前权威机构统计约在口腔癌中居第六位[1]。口底癌可发生于一侧或双侧口底,病理学诊断多为中度分化的鳞状细胞癌。口底癌早期表现为较大的长期不愈合溃疡样病损,之后逐渐发生口底肌群的侵犯并常伴发疼痛。口底癌发展较快,可累及邻近组织,也可能穿过肌层进入颏下及下颌下区。口底癌常较早出现淋巴结转移,一般先转移至颏下、下颌下淋巴结,以后转移到颈深淋巴结,并常发生双侧颈淋巴结转移[2]。口底癌的治疗仍首选手术治疗,临床常行口底、下颌骨、颈淋巴联合根治术。对双侧颈淋巴结转移的患者,可同时或分期行颈淋巴清扫术。对于口底癌病灶切除后引起的组织缺损,常根据缺损的大小选择不同的组织瓣进行修复。颈阔肌皮瓣在临床上是一种较好的选择[3]。但颈阔肌皮瓣在修复口底癌的术后缺损中,存在一定的局限性并有着较多的技术细节要求,本次研究意在探讨颈阔皮瓣用于口底癌术后缺损修复的可行性。现报道如下。
1 对象与方法
1.1 研究对象
本次研究首先收集了我科自2008年3月~2013年3月收治的12例应用颈阔肌皮瓣进行修复的口底癌患者进行回顾性分析,其中男10例,女2例。患者年龄最大67岁,最小51岁,平均年龄(61.0±8.0)岁。肿瘤分期T1期3例,T2期7例,T3期2例(表1),其中2例患者术后病理证实出现单侧颌下淋巴结转移(N1期),所有患者均未发生远端转移,即M0期。肿瘤TNM分期是以口腔癌和口咽癌的国际抗癌联盟(UICC)2010年的分期标准进行。具体为:T1:肿瘤最大直径≤2 cm;T2:肿瘤最大直径>2 cm,≤4 cm;T3:肿瘤最大直径>4 cm。N0:无淋巴结转移;N1:同侧单个淋巴结转移,直径≤3 cm。M0:无远处转移[4]。患者诊断的标准全部根据术中及术后病理结果回报,均为鳞状细胞癌,其中高分化5例,中分化7例。上述患者均于术前签属知情同意书。手术由我科同一资深术者完成。另收集同一时期口底癌进行的其他皮瓣修复的患者12例,男9例,女3例,平均年龄(62.1±7.6)岁,其中前臂瓣6例,胸大肌4例,股前外侧皮瓣2例。纳入标准除未应用颈阔肌皮瓣以外与上述相同。以上24例患者均进行术后2年以上的随访。将应用颈阔肌皮瓣的12例患者设为Ⅰ组,未应用颈阔肌皮瓣而应用其他皮瓣的12例患者设为Ⅱ组。两组患者的性别、年龄及TNM分期比较差异无统计学意义(P>0.05),具有可比性,见表1。, 百拇医药(才越 谭学新 佟爽 胡玉乾 张仁儒 )