273例口腔颌面部游离皮瓣中14例皮瓣危象的相关因素分析

摘要/Abstract

摘要： 目的分析口腔颌面部游离皮瓣危象发生的相关因素,以便总结经验,提高游离皮瓣移植的成功率。方法 2006—2015年共制备 273例游离皮瓣,其中259 例成功 ,14 例发生皮瓣危象。对发生皮瓣危象患者的相关危险因素应用SPSS21.0 软件包进行连续性校正χ²检验,同时统计14例皮瓣危象患者在发生皮瓣危象6 h内积极抢救的成功率。结果游离皮瓣危象与患者小气道功能障碍、患者常年饮酒所导致的酒精戒断症状,以及超重（即BMI数值>25）无显著相关性(P>0.05）,但与患者术后发生感染显著相关（P<0.01）。皮瓣危象时间超过72 h的患者,抢救成功率为33.3%。结论局部或全身感染是皮瓣危象的一个相关危险因素,BMI过高、小气道功能障碍、患者发生酒精截断症状与皮瓣危象无关。皮瓣危象发生时间越晚,皮瓣的抢救成功率越低。一旦发生皮瓣危象,即使超过72 h,及早探查、纠正危象原因,也能取得一定的抢救成功率。

关键词: 游离皮瓣, 手术探查, 皮瓣危象, 危险因素

Abstract: PURPOSE: To investigate related risk factors of flap crisis in head and neck reconstruction, summarize experiences, and improve the success rate. METHODS: We retrospectively reviewed 273 free flaps for head and neck defect reconstruction from 2006 to 2015. Among those, 14 cases developed from flap crisis. The related risk factors were analyzed, and the salvage success rate within 6 h from the initial suspicion of flap crisis was assessed. SPSS 21.0 software package was employed to analyze the data. RESULTS: Risk factors such as small airway dysfunction, alcohol withdrawal reaction, overweight (BMI>25) were not related to the incidence of flap crisis (P>0.05). However, local or systemic postoperative infection was significantly related to flap crisis (P<0.01). The salvage rate of surgical exploration was 33.3% over 72 h postoperatively. CONCLUSIONS: Local or systemic infection was a high risk factor for free flap crisis. Greater BMI, small airway dysfunction, and alcohol withdrawal reaction were not related to free flap crisis. The later the free flap crisis occurred, the lower salvage rate. Once suspicious flap crisis occurs, even more than 72 h after operation, surgical exploration also benefits in helping to improve salvage rate.

Key words: Free flaps, Surgical exploration, Flap crisis, Risk factors

中图分类号:

R782.2

王佳, 白爽, 孙长伏, 刘法昱, 徐中飞. 273例口腔颌面部游离皮瓣中14例皮瓣危象的相关因素分析[J]. 中国口腔颌面外科杂志, 2016, 14(6): 538-541.

WANG Jia, BAI Shuang, SUN Chang-fu, LIU Fa-yu, XU Zhong-fei. Analysis of risk factors of free flap crisis in 14 of 273 consecutive patients with free flap reconstruction of oral and maxillofacial defects[J]. China J Oral Maxillofac Surg, 2016, 14(6): 538-541.

参考文献

[1] 张陈平, 张志愿, 邱蔚六, 等. 口腔颌面部缺损的修复重建: 1973例临床分析[J]. 中国修复重建外科杂志, 2005, 19(10): 773-776.
[2] 胡永杰, 曲行舟, 郑家伟, 等. 游离组织瓣在口腔颌面-头颈肿瘤缺损修复中的应用: 2549例临床分析 [J]. 中国口腔颌面外科杂志, 2007, 5(5): 335-339.
[3] Nakatsuka T, Harii K, Asato H, et al. Analytic review of 2372 free flap transfers for head and neck reconstruction following cancer resection [J]. J Reconstr Microsurg, 2003, 19(6): 363-368.
[4] Yu P, Chang DW, Michael MJ, et al. Analysis of 49 cases of flap compromise in 1310 free flaps for head and neck reconstruction [J]. Head Neck, 2009, 31(1): 45-51.
[5] Urken ML, Weinberg H, Buchbinder D, et al. Microvascular free flaps in head and neck reconstruction. Report of 200 cases and review of complications [J]. Arch Otolaryngol Head Neck Surg, 1994, 120(6): 33-640.
[6] Bozikov K, Arnez ZM. Factors predicting free flap complications in head and neck reconstruction [J]. J Plast Reconstr Aesthet Surg, 2006, 59(2): 737-742.
[7] 陈凯, 廖贵清, 钟奇帜. 前臂游离皮瓣修复舌癌术后缺损26例临床疗效分析 [J].中国实用口腔科杂志, 2011, 4(4): 242-244.
[8] Khouri RK, Cooley BC, Kunselman AR, et al. A prospective study of microvascular free-flap surgery and outcome [J]. Plast Reconstr Surg, 1998, 102(3): 711-721.
[9] Hidalgo DA, Jones CS. The role of emergent exploration in free-tissue transfer: a review of 150 consecutive cases [J]. Plast Reconstr Surg, 1990, 86(3): 492-498.
[10] 王天祥, 于鸿潜, 刘屹嵩, 等. 2种血管吻合方式对游离组织瓣修复口腔颌面部缺损中皮瓣成活的影响 [J]. 现代口腔医学杂志, 2012, 26(6): 370-372.
[11] Piazza C, Taglietti V, Paderno A, et al. End-to-end versus end-to-side venous microanastomoses in head and neck reconstruction [J]. Eur Arch Otrohinolaryngol, 2014, 271(1): 157-162.
[12] Khori RK, Cooley BC, Kenna DM, et al. Thrombosis of microvascular anastomoses in traumatized vessels: fibrin versus platelets [J]. Plast Reconstr Surg, 1990, 86(4): 110-117.
[13] 徐中飞, 谭学新, 秦兴军, 等. 影响头颈部游离皮瓣移植成活的因素分析 [J]. 中国口腔颌面外科杂志, 2010, 8(3): 265-268.
[14] 叶为民, 张志愿, 竺涵光, 等. 口腔颌面部游离组织瓣危象的观察和处理：附44例报告 [J]. 上海口腔医学, 2004, 13(2): 91-94.
[15] 杨文宾, 李春洁, 李龙江, 等. 口腔颌面部肿瘤患者术后感染细菌及耐药性分析 [J].上海口腔医学, 2015, 24(5): 584-588.
[16] 包荣华, 陈杰, 喻建军. 口腔颌面肿瘤术后感染的原因分析与预防 [J]. 实用预防医学, 2007, 14(2): 502-504.
[17] Karakida K, Aoki T, Ota Y, et al. Analysis of risk factors for surgical-site infections in 276 oral cancer surgeries with microvascular free-flap reconstructions at a single university hospital [J]. J Infect Chemother, 2010, 16(5): 334-339.
[18] 毛驰, 彭歆, 张雷, 等. 术前放射治疗对头颈部游离组织瓣移植的影响 [J]. 中华口腔医学杂志, 2007, 42(2): 67-69.
[19] 陈佳伟, 黄燕, 徐辉, 等. 头颈部手术后谵妄危险因素的meta 分析[J]. 中国口腔颌面外科杂志, 2015, 13(2): 175-181.
[20] 姜蕾, 陈潇卿, 石荣华, 等. 前臂桡侧游离皮瓣静脉回流障碍的临床观察: 附13例报道 [J]. 中国口腔颌面外科杂志, 2012, 10(2): 146-150.