天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (5): 527-532.doi: 10.11958/20171064

• 临床研究 • 上一篇    下一篇

应用颏下岛状瓣修复口腔癌术后缺损

孟丽1 ， 沈军2 ， 刘浩2 ， 穆洁2 ， 陈伟2 ， 张军2 ， 王超2 ， 严颖彬2   

  1. 1天津医科大学 （邮编300070）； 2天津市口腔医院口腔颌面外科
  • 收稿日期:2017-10-11 修回日期:2018-03-28 出版日期:2018-05-15 发布日期:2018-05-15
  • 通讯作者: 严颖彬 E-mail:yingbinyan@qq.com

Submental island flap for repairing oral defect after radical resection of oral cancer

MENG Li 1 , SHEN Jun2 , LIU Hao2 , MU Jie2 , CHEN Wei 2 , ZHANG Jun2 , WANG Chao2 , YAN Ying-bin2   

  1. 1 Tianjin Medical University, Tianjin 300070, China; 2 Department of Oral and Maxillofacial Surgery, Tianjin Stomatological Hospital
  • Received:2017-10-11 Revised:2018-03-28 Published:2018-05-15 Online:2018-05-15
  • Contact: Ying-Bin Yan E-mail:yingbinyan@qq.com

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摘要： 摘要： 目的 总结颏下岛状瓣的制备技巧及修复口腔癌术后缺损的临床效果。方法 回顾性分析2015年1 月—2017年5月应用颏下岛状瓣修复口腔癌术后缺损的患者25例， 总结颏下岛状瓣的静脉回流特点、 手术技巧和术后并发症。通过随访分析颏下岛状瓣修复口腔癌术后缺损的安全性。结果 皮瓣切取大小为 （5 cm×3 cm） ~ （12 cm× 5 cm）， 平均手术时间 （350.5±50.5） min。皮瓣通过面前静脉回流至颈内静脉17例 （68.0%）、 颈外静脉4例 （16.0%）、 颈前静脉4例 （16.0%）。除1例因术中损伤颏下动脉弃去皮瓣外， 其余24例均完全成活。术后1例发生伤口感染， 其余 24例伤口均一期愈合。术后8例 （32.0%） 证实颈部淋巴结转移， 其中4例为颌下淋巴结转移， Ⅰ区淋巴结转移率为 16.0%。平均随访 （14.3±5.2） 个月， 1例原发灶复发， 2例颈部复发， 均为术后未放疗患者。结论 颏下岛状瓣的静脉回流方式存在变异， 制备皮瓣时应特别注意回流至颈外静脉和颈前静脉的情况， 以避免回流障碍及皮瓣坏死。对于术后颈部淋巴结阴性的患者， 应密切随访或辅助放疗， 警惕皮瓣及血管蒂周围淋巴结转移的风险。

关键词: 口腔肿瘤, 口腔外科手术, 外科皮瓣, 颏下岛状瓣, 颌面缺损修复

Abstract: Abstract: Objective To summarize the surgery skills and evaluate the clinical outcome of submental island flap for repairing oral defect after radical resection of oral cancer. Methods A total of 25 consecutive patients underwent submental island flap reconstruction after ablative surgery for oral cancer from January 2015 to May 2017 were enrolled in this study. The patterns of venous return, the technique notes and postoperative complications were summarized. The oncological safety of submental island flap in oral reconstruction was analyzed. Results The submental island flaps were harvested with the sizes ranging from (5 cm×3 cm) to (12 cm×5 cm). The mean operation time was (350.5±50.5) min. The vein of the flap was found to drain into the facial vein, and then returned to the internal jugular vein in 17 patients (68.0%), into the external jugular vein in 4 patients (16%), and into the anterior jugular vein in 4 patients (16%). Twenty-four flaps survived completely, and 1 flap failed due to the damage of the submental artery. Wound infection occurred in only 1 patient, and primary wound healing was observed in the other 24 patients. Eight patients (32.0%) with cervical lymph node metastases were verified by the postoperative pathological examination, 4 patients were submandibular lymph node metastases. The prevalence of occult lymph node metastasis involving level Ⅰ was 16.0%. The mean follow-up period was (14.3 ± 5.2) months. Local recurrence was found in 1 patient and cervical recurrence in 2 patients without postoperative radiotherapy during the follow-up. Conclusion There are three various drainage patterns for the venous return of submental island flap. Our data suggest that vein drainage of the flap into the external jugular vein and the anterior jugular vein, which are previously overlooked, should receive greater attention during the harvest of submental flap to avoid venous congestion and flap loss. Close follow-up or postoperative radiotherapy are recommended for patients without cervical lymph node metastases.

Key words: mouth neoplasms, oral surgical procedures, surgical flaps, submental island flap, maxillofacial defect repair