股前外侧皮瓣与前臂皮瓣修复口腔鳞癌术后软组织缺损的效果与质量比较的meta分析

doi:10.19438/j.cjoms.2026.06.011

摘要/Abstract

摘要： 目的: 系统评价股前外侧皮瓣（anterolateral thigh flap, ALTF）与前臂皮瓣（forearm flap, FF）修复口腔鳞癌术后软组织缺损的效果与质量。方法: 系统检索PubMed、Embase、Medline、Cochrane Library、CNKI、万方、维普等数据库关于ALTF与FF修复口腔鳞癌患者术后软组织缺损的文献,检索时间为建库至2024年10月1 日。由研究者严格按照纳入及排除标准进行文献收集、质量评价、数据提取,并交叉核对,然后采用 RevMan 5.4 软件进行meta分析。结果: 最终纳入36项研究,共2 570例患者。Meta分析结果显示,在皮瓣制备时间上,FF显著少于ALTF[MD=3.73,95%CI（0.20,7.26）,P=0.04],但两者手术总时长无显著差异[MD=17.20,95%CI（-9.33,43.73）,P=0.20]。在术后术区并发症方面,ALTF有着更低的术后色素沉着、瘢痕增生、术区感觉异常发生率 [OR=0.07,95%CI（0.03, 0.16）,P<0.00001;OR=0.18,95%CI（0.11,0.29）,P<0.00001;OR=0.24,95%CI（0.1,0.59）,P=0.002]。在术后口腔功能方面,ALTF有着更低的术后暂时性/永久性功能障碍发生率[OR=0.10,95%CI（0.06,0.15）,P<0.00001;OR=0.12,95%CI（0.05,0.25）,P<0.00001]。术后咀嚼功能评分,ALTF显著优于FF [MD=0.72,95%CI（0.62,0.82）,P<0.00001]。结论: FF可在一定程度上降低皮瓣制备难度,缩短制备时间,更适用于新开展游离皮瓣的医师或单位;而ALTF相比FF有着更低的术后并发症发生率,并且术后口腔功能恢复优于FF。因此,若以降低术后并发症发生的风险或追求更好恢复口腔功能为目标,ALTF是更优的选择。

关键词: 股前外侧皮瓣, 前臂皮瓣, 口腔鳞癌, 并发症, 口腔功能, Meta分析

Abstract: PURPOSE: To systematically evaluate the effectiveness and quality of anterolateral thigh flaps(ALTF) and forearm flaps (FF) for repairing soft tissue defects after oral squamous cell carcinoma surgery. METHODS: The literatures on the repair of soft tissue defects in patients with oral squamous cell carcinoma after surgery by ALTF and FF were systematically retrieved from databases such as PubMed, Embase, Medline, Cochrane Library, CNKI, Wanfang, and VIP. The retrieval time was from the establishment of the databases to October 1, 2024. The researchers conducted literature collection, quality evaluation, data extraction strictly in accordance with the inclusion and exclusion criteria, and cross-checked. Then, meta-analysis was performed using RevMan 5.4 software. RESULTS: A total of 36 studies were finally included,involving 2 570 patients. The results of meta-analysis showed that in terms of flap preparation time, the time for FF was significantly less than that for ALTF [MD=3.73, 95%CI(0.20, 7.26), P=0.04], but there was no significant difference in the total duration of operation [MD=17.20, 95%CI(-9.33, 43.73), P=0.20]. In terms of postoperative complications in the surgical area, ALTF had a lower incidence of postoperative pigmentation, hypertrophic scarring, and abnormal sensation in the surgical area [OR=0.07, 95%CI(0.03, 0.16), P<0.00001; OR=0.18, 95%CI(0.11, 0.29), P<0.00001; OR=0.24, 95%CI(0.10, 0.59), P=0.002]. In terms of postoperative oral function, ALTF had a lower incidence of temporal/permanent functional impairment [OR=0.10, 95%CI (0.06, 0.15), P<0.00001; OR=0.12, 95%CI(0.05, 0.25), P<0.00001], and ALTF also significantly outperformed FF in terms of postoperative chewing function scores [MD=0.72, 95%CI (0.62, 0.82), P<0.00001]. CONCLUSIONS: FF can reduce the technical difficulty of flap harvesting and shorten operative time, making it more suitable for surgeons or institutions newly adopting free flap techniques. In contrast, ALTF demonstrates a lower incidence of postoperative complications and provides superior oral functional recovery compared to FF. Therefore, if the goal is to minimize postoperative complication risks or achieve better oral functional rehabilitation, ALTF is the preferred choice.

Key words: Anterolateral thigh flap, Forearm flap, Oral squamous cell carcinoma, Complications, Oral function, Meta analysis

中图分类号:

战放, 王可心, 何宗轩, 王琳, 宋凯, 尚伟. 股前外侧皮瓣与前臂皮瓣修复口腔鳞癌术后软组织缺损的效果与质量比较的meta分析[J]. 中国口腔颌面外科杂志, 2026, 24(1): 65-77.

Zhan Fang, Wang Kexin, He Zongxuan, Wang Lin, Song Kai, Shang Wei. Comparison of the efficacy and quality of repair of soft tissue defects after oral squamous cell carcinoma with anterolateral thigh flap and forearm flap: a meta-analysis[J]. China J Oral Maxillofac Surg, 2026, 24(1): 65-77.

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