基于解剖学的“五点八线区”技术用于标准化次全舌重建效果评价

doi:10.19438/j.cjoms.2019.05.006

摘要/Abstract

摘要： 目的：使用基于解剖学的“五点八线区”皮瓣设计技术进行次全舌重建,并进行临床疗效评价。方法：44例舌鳞癌患者采用股前外侧皮瓣进行次全舌重建。根据皮瓣设计方法随机分为2组,分别为“五点八线区”（five-points eight-line-segments, FIPELS）组（23例）和传统皮瓣移植组（21例）。所有患者均进行神经重建,将皮瓣的皮神经与舌神经或舌咽神经吻合。利用Likert量表评估吞咽功能、语言清晰度和美观度,并评价重建舌的精细觉、本体感觉的敏感性、温度觉。采用SPSS 18.0软件包进行统计学分析。结果：除3例患者出现部分坏死外,其余皮瓣均愈合良好。与传统方法相比,FIPELS技术可以获得更大面积的皮瓣;FIPELS组患者的吞咽功能（P=0.016）和美观度（P=0.001）显著改善,但语言清晰度无显著提高（P=0.064）。2组患者在精细觉、本体感觉的敏感性、温度觉方面恢复效果相近。结论：使用基于解剖学的FIPELS技术进行精确次全舌重建,能获得理想的临床效果,值得推广应用。

关键词: 五点八线区, 次全舌重建, 股前外侧皮瓣, 舌癌

Abstract: PURPOSE: To explore a flap design technique based on anatomy to achieve precise subtotal tongue reconstruction and evaluate the clinical efficacy. METHODS: Forty-four patients suffering from tongue squamous carcinoma received subtotal tongue reconstruction with anterolateral thigh flap, they were randomly divided into 2 groups according to flap design methods, a "five-points eight-line-segments"(FIPELS) group (23 patients) and a conventional flap design group (21 patients). All patients received nerve coaptation to the lingual or glossopharyngeal nerve. Likert scale was applied to assess the swallowing function, speech articulation, cosmetic outcomes, as well as epicritic sensation, proprioception and thermal sensitivity of the reconstructed tongue. The outcomes were analyzed by SPSS 18.0 software package. RESULTS: All flaps healed well, except 3 patients developed partial necrosis. FIPELS group attained larger area of flap than conventional group. Compared to the conventional group, the swallowing function (P=0.016) and cosmetic outcomes (P=0.001) in FIPELS group were significantly improved, but the speech articulation failed to achieve better outcome (P=0.064). Patients in both groups recovered similarly in epicritic sensation proprioception and thermal sensitivity. CONCLUSIONS: The clinical efficacy of FIPELS design based on anatomy for precise subtotal tongue reconstruction is remarkable and worthy of popularization.

Key words: Five-points eight-line-segments, Subtotal tongue reconstruction, Anterolateral thigh flap, Tongue cancer

中图分类号:

R782.2

王洁琪, 张汉卿, 李群星, 王张嵩, 方泽震, 李劲松, 范松. 基于解剖学的“五点八线区”技术用于标准化次全舌重建效果评价[J]. 中国口腔颌面外科杂志, 2019, 17(5): 418-423.

WANG Jie-qi, ZHANG Han-qing, LI Qun-xing, WANG Zhang-song, FANG Ze-zhen, LI Jin-song, FAN Song. Evaluation of "five-point eight-line-segments" anatomic flap design for precise subtotal tongue reconstruction[J]. China J Oral Maxillofac Surg, 2019, 17(5): 418-423.

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