中国修复重建外科杂志

中国修复重建外科杂志

面动脉黏膜肌皮瓣修复舌及口底肿瘤切除后缺损疗效观察

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目的 探讨采用面动脉黏膜肌皮瓣修复舌及口底肿瘤切除后缺损的临床疗效。 方法 2011 年 1 月—2016 年 1 月,采用面动脉黏膜肌皮瓣修复肿瘤切除后引起舌及口底组织缺损 24 例。其中男 16 例,女 8 例;年龄 38~70 岁,平均 55 岁。病程 1 周~6 个月,平均 4 个月。缺损部位:口底 4 例,舌 15 例,口底舌腹 5 例。其中口底鳞癌 2 例,口底腺样囊性癌 2 例,舌鳞癌 14 例,舌腺样囊性癌 1 例,口底舌腹鳞癌 5 例。肿瘤切除后舌及口底缺损范围为 4 cm×3 cm~8 cm×7 cm。切取面动脉黏膜肌皮瓣位于原发灶同侧 3 例,对侧 21 例(其中 5 例因缺损面积较大采用面动脉黏膜肌皮瓣及颏下肌岛状皮瓣共同修复)。面动脉黏膜肌皮瓣切取范围 5 cm×4 cm~5 cm×5 cm,颏下肌岛状皮瓣切取范围 4 cm×3 cm~5 cm×4 cm。 结果 术后所有皮瓣全部成活,无局部坏死发生。供区出现伤口裂开 5 例,经局部伤口清洗处理后愈合;余 19 例供受区创面Ⅰ期愈合。24 例患者均获随访,随访时间 8 个月~5 年,平均 2 年 4 个月。术后面部无明显畸形,无口底漏。术后 16 例出现面神经下颌缘支损伤临床表现,3 个月后恢复正常。所有患者术后出现张口受限,1 年后 20 例恢复正常,4 例仍有张口 2 指受限。患者进食、吞咽、语言等功能均无影响。 结论 面动脉黏膜肌皮瓣手术简便、整复效果理想、皮瓣成活率较高、供区损伤少、术后护理简单、术后无需制动,适宜于舌及口底缺损修复。

Objective To explore the effect of facial artery musculo-mucosal (FAMM) flap to reconstruct tongue and floor of mouth defects. Methods Between January 2011 and January 2016, 24 cases of tongue and floor of mouth defects were repaired with FAMM flap after tumor resection. There were 16 males and 8 females, aged from 38 to 70 years with an average of 55 years. The disease duration was from 1 week to 6 months with an average of 4 months. The defect located at the floor of mouth in 4 cases, at the tongue in 15 cases, and both tongue and floor of mouth in 5 cases. There were 2 cases of carcinoma at the floor of mouth, 2 cases of adenoid cystic carcinoma at the floor of mouth, 14 cases of carcinoma at the tongue, 1 case of adenoid cystic carcinoma at the tongue, and 5 cases of carcinoma at the tongue and floor of mouth. The size of defect ranged from 4 cm×3 cm to 8 cm×7 cm. Three ipsilateral and 21 contralateral FAMM flaps were harvested (5 cases were repaired with FAMM flap and submental muscle island flap due to the large defect area). The size of FAMM flap ranged from 5 cm×4 cm to 5 cm×5 cm, the size of submental muscle island flap ranged from 4 cm×3 cm to 5 cm×4 cm. Results All flaps survived after operation, without local necrosis. Wound dehiscence at donor site occurred in 5 cases, and healed after cleaning; primary healing was obtained in the other 19 cases. All the patients were followed up 8 months to 5 years with an average of 2 years and 4 months. No obvious facial deformity or fistula of the floor of mouth occurred after operation. Injury of the submandibular branch of the facial nerve was observed in 16 patients, who returned to normal at 3 months. All 24 patients had limitation of mouth opening after operation, which disappeared after 12 months. The functions of speech, chewing, and swallowing were normal. Conclusion FAMM flap has many advantages of simple operation, good repair, high flap survival rate, and less injury at donor site for repairing tongue and floor of mouth defects.

关键词: 舌及口底缺损; 面动脉黏膜肌皮瓣; 恶性肿瘤

Key words: Tongue or floor of mouth defects; facial artery musculo-mucosal flap; malignancy

引用本文: 潘孟雄, 毛峻武, 马韬, 覃小荣, 李波. 面动脉黏膜肌皮瓣修复舌及口底肿瘤切除后缺损疗效观察. 中国修复重建外科杂志, 2017, 31(4): 461-464. doi: 10.7507/1002-1892.201611108 复制

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