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目的探讨游离前臂皮瓣移植修复治疗口腔颌面部肿瘤切除后缺损的临床效果。方法回顾性分析温州医科大学附属第一医院2013年1月—2015年12月间收治的47例口腔颌面部肿瘤患者病例,患者肿瘤切除术后均给予游离前臂皮瓣移植修复治疗。统计患者皮瓣成活及并发症情况,对患者吞咽功能、语音功能进行评价,并对患者治疗前后血清唾液酸(SA)和白细胞介素(IL)-2水平变化进行比较。结果所有患者均进行手术,经病灶切除、皮瓣设计、皮瓣切取、吻合修复等步骤对患者进行修复治疗。术后随访6~18个月,皮瓣成活率达到了95.7%(45/47)。术后1个月,患者血清SA水平为(0.72±0.24)mg/L,显著低于术前的(0.96±0.27)mg/L(P<0.05);术后1个月,患者血清IL-2水平为(13.94±4.12)μg/L,显著高于术前的(5.69±1.38)μg/L(P<0.05)。术后3个月,患者吞咽功能:2级9例(19.1%)、3级38例(80.9%)。术后6个月,34例(72.3%)患者发音清晰。并发症包括:瘢痕14例(29.8%)、色素沉着39例(83.0%)、瘙痒24例(51.1%)、皮区感觉异常43例(91.5%)。结论游离前臂皮瓣修复治疗口腔颌面部组织缺损效果满意,皮瓣成活率高、吞咽功能恢复良好。
Objective To investigate the clinical effect of free forearm flap transplantation for the treatment of oral and maxillofacial tumor excision. Methods The clinical data of 47 cases of oral and maxillofacial tumors admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2013 to December 2015 were retrospectively analyzed. The patients were treated with free forearm flap transplantation after tumor resection. Survival and complications of the flaps of the patients were evaluated. The swallowing function and speech function of the patients were evaluated, and the changes of serum sialic acid (SA) and interleukin (IL) -2 before and after treatment were compared. Results All the patients underwent surgery, and the patients were repaired by the procedure of resection of the lesion, flap design, skin flap removal and anastomosis repair. After 6 to 18 months of follow-up, the survival rate of the flap reached 95.7% (45/47). Serum SA level was (0.72 ± 0.24) mg / L at one month after operation, which was significantly lower than that before operation (0.96 ± 0.27) mg / L (P <0.05) 2 level was (13.94 ± 4.12) μg / L, which was significantly higher than that of preoperative (5.69 ± 1.38) μg / L (P <0.05). At 3 months after operation, the swallowing function of patients was grade 2 in 9 cases (19.1%) and in grade 3 in 38 cases (80.9%). Six months after operation, 34 patients (72.3%) had clear articulation. Complications included scarring in 14 (29.8%), pigmentation in 39 (83.0%), pruritus in 24 (51.1%) and skin sensation in 43 (91.5%). Conclusion The results show that the free forearm flap is satisfactory for the treatment of oral and maxillofacial tissue defects, the flap survival rate is high, and the swallowing function is recovered well.