头颈部缺损重建术后持续性口底瘘或口咽瘘的救治性治疗

doi:10.19438/j.cjoms.2021.04.015

中国口腔颌面外科杂志 ›› 2021, Vol. 19 ›› Issue (4): 362-367.doi: 10.19438/j.cjoms.2021.04.015

头颈部缺损重建术后持续性口底瘘或口咽瘘的救治性治疗

马春跃, 朱云, 郭兵, 王良, 沈毅

上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科,上海交通大学口腔医学院, 国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海 200011

收稿日期:2020-10-29 修回日期:2021-03-04 出版日期:2021-07-20 发布日期:2021-08-05
通讯作者: 沈毅,E-mail：shenyi_777@sina.com
作者简介:马春跃（1984-）,男,博士,主治医师,E-mail：maxifama@163.com

Re-reconstructions for cases with persistent post-reconstructive orocutaneous or oropharyngocutaneous fistulas after extensive reconstructive operations in head and neck region

MA Chun-yue, ZHU Yun, GUO Bing, WANG Liang, SHEN Yi

Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology. Shanghai 200011, China

Received:2020-10-29 Revised:2021-03-04 Online:2021-07-20 Published:2021-08-05

摘要/Abstract

摘要： 目的： 探讨对持续性难治性口底瘘或口咽瘘的患者,运用清创+皮瓣修复的方法进行治疗的效果及预后影响因素。方法： 回顾性分析上海交通大学医学院附属第九人民医院2009年1月—2018年12月因持续性口咽瘘和口底瘘,而进行二期或三期清创及皮瓣修复重建的患者。总结瘘管发生的可能原因,修复重建的方法,相关并发症及随访结果,并对预后影响因素进行Cox多因素分析。结果： 共纳入31例患者,19例（61.3%）为口底瘘,12例（38.7%）为口咽瘘,修复重建手术中,股前外侧皮瓣占15例（48.4%）是最常用的皮瓣。19例患者（61.3%）有既往头颈部放疗史。在持续性难治性口咽瘘和口底瘘的皮瓣修复方法上,股前外侧皮瓣占8例（25.8%）,胸大肌皮瓣占18例（58.1%）,腓骨皮瓣占3例（9.7%）,所有皮瓣术后均成活。并发症发生率为38.7%（12/31）,以肺部感染和轻微术区伤口裂开最为常见,随访期间患者总生存率为58.1%（18/31）。经Cox多因素分析,与总生存率相关的预后因素包括并发症（P=0.043）、瘘管形成至修补修复的时间间隔（P=0.025）。结论： 对于难治性持续性口底瘘或口咽瘘的病例,清创及皮瓣修复手术具有挑战性,需要详细周密的手术计划和熟练的修复重建技术方能完成。

关键词: 修复重建, 口底瘘, 口咽瘘

Abstract: PURPOSE: Orocutaneous or oropharyngeal fistulas may develop after extensive surgery in the head and neck region. This paper described our experiences in applying salvage secondary or tertiary reconstructions in these situations. METHODS: A retrospective study was performed based on the 10-year experiences of secondary or tertiary reconstructions for correction of persistent post-reconstructive orocutaneous or oropharyngocutaneous fistulas in our institution. Thirty-one cases were considered as eligible. The possible causes for these fistulas were recorded. The salvage reconstructive approaches were summarized, while related complications and follow-up outcomes were reported as well. Multivariate statistical analyses for the survival-related factors were performed using SPSS 25 software package. RESULTS: Among all these cases, 19 cases(61.3%) were with post-reconstructive orocutanenous fistulas, while 12(38.7%) were with oropharyngocutaneous fistulas. Anterolateral thigh flaps(n=15, 48.4%) were the most used flaps in the failed prior operations. Most of the cases(n=19, 61.3%) were with histories of prior irradiation. As for the specific salvage reconstructive approaches, 8 cases (25.8%) were re-reconstructed with anterolateral thigh free flaps, while 18(58.1%) were with pectoralis major myocutaneous flaps and 3(9.7%) with fibular flaps, respectively. All re-reconstructive flaps survived postoperatively. Complication rate reached 38.7%(12/31),with pulmonary infections and minor wound dehiscence representing the most likely ones. The overall survival rate reached 58.1%(18/31) calculated at recent follow-ups. CONCLUSIONS: Secondary or tertiary reconstructions for these cases are challenging. Careful planning and considerable expertise in re-reconstructive surgery are both required for successful management of these serious complications.

Key words: Reconstruction surgery, Orocutaneous, Oropharyngocutaneous

中图分类号:

R782.2

马春跃, 朱云, 郭兵, 王良, 沈毅. 头颈部缺损重建术后持续性口底瘘或口咽瘘的救治性治疗[J]. 中国口腔颌面外科杂志, 2021, 19(4): 362-367.

MA Chun-yue, ZHU Yun, GUO Bing, WANG Liang, SHEN Yi. Re-reconstructions for cases with persistent post-reconstructive orocutaneous or oropharyngocutaneous fistulas after extensive reconstructive operations in head and neck region[J]. China J Oral Maxillofac Surg, 2021, 19(4): 362-367.

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头颈部缺损重建术后持续性口底瘘或口咽瘘的救治性治疗

Re-reconstructions for cases with persistent post-reconstructive orocutaneous or oropharyngocutaneous fistulas after extensive reconstructive operations in head and neck region

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