微血管吻合器在游离股前外侧皮瓣修复口腔癌术后软缺损中的应用

摘要

目的：探讨微血管吻合器在游离股前外侧皮瓣修复口腔癌术后软缺损中的应用。方法回顾性分析2013年9月至2014年9月52例在中南大学湘雅二医院口腔颌面外科就诊的口腔癌患者的临床资料，全部患者行功能性颈清扫＋原发灶切除＋游离股前外侧皮瓣修复术，其中27例患者游离股前外侧皮瓣修复术中的静脉采用手工显微外科行端端吻合，25例患者游离股前外侧皮瓣移植后的静脉应用微血管吻合器行端端吻合。结果以微血管吻合器行静脉吻合时间为（6．3±1．9）min，较手工吻合时间（12．3±1．4）min 缩短，差异具有统计学意义（P ＝0．001）。25例患者应用25枚微血管吻合器行静脉端端吻合，血管吻合后术中所有游离股前外侧皮瓣静脉吻合口均未出现漏血、吻合器脱落、张力过大而撕裂、血栓形成导致皮瓣静脉危象等情况，术后亦未出现动、静脉血管危象；27例患者采用手工显微外科吻合40根静脉，术后有2例患者出现静脉血管危象。结论微血管吻合器在游离股前外侧皮瓣修复口腔癌术后软组织缺损中静脉吻合质量高、时间短，术后并发症少。%Objective To evaluate the clinical value of microvascular anastomotic devices in free anterolateral thigh flap in the recon-struction of oral carcinoma defects.Methods From September 2013 to September 2014,52 patients with oral cancer were treated by func-tional neck cleaning,primary tumors resection,and free anterolateral thigh flap in the reconstruction.Of which 27 patients received free of femoral anterolateral flap to repair veins by using microsurgical line end to end anastomosis.And 25 pieces of microvascular anastomotic ad-vices were applied in 25 patients with oral carcinoma defects.The length of anastomosis time,flap survival rate,and complications were recor-ded.Results In 52 patients,microvascular anastomotic devices were applied in 25 veins with shorter anastomosis time,(6.3 ±1.9)min vs. (12.3 ±1.4)min,and the difference was significant(P =0.001).The flap survival rate and vascular anastomosis patency rate was 100%.No intra-and post-operative complications such as blood leak,stapling,excessive tension and tear,thrombosis in flap vein crisis associated with microvascular anastomotic devices were observed.Twenty-seven patients with 40 root vein received manual microsurgical anastomosis,2 of them showed vein crisis.Conclusion The microvascular anastomotic devices used in repairing the soft tissue defects by anterolateral thigh flap with venous anastomosis for patients of oral cancer after surgery has the advantage of higher quality,shorter time and less complications.