CAJ | 학술논문

目的：探讨颏下岛状皮瓣（SIMF）和游离皮片（FSG）在修复老年患者颊癌术后颊部缺损的临床应用效果。方法44例老年颊癌患者行颊癌根治术和颈淋巴清扫术后同期分别应用颏下SIMF（n＝19）和FSG（n＝25）修复颊部缺损。比较两组患者术后颊部外形恢复程度、开口受限程度、语音功能、咀嚼功能等情况。结果 SIM F组1例出现皮岛坏死，清创后发现肌瓣血运良好，其余全部成活，皮瓣移植成功率94．7％（18/19），供区直接拉拢缝合FSG组的移植成功率为100．0％（25/25）；SIMF组所有病例术后12个月随访，颊部外形恢复程度、张口受限程度、语音功能、咀嚼功能均优于FSG组（ P＜0．05）。FSG组有1例术后5月出现原发灶复发。两组间在复发转移情况方面差异无统计学意义（P＞0．05）。结论颏下SIMF适合老年患者颊癌切除术后组织缺损的修复，提高了患者术后生存质量，具有较好的临床应用前景。
목적：탐토해하도상피판（SIMF）화유리피편（FSG）재수복노년환자협암술후협부결손적림상응용효과。방법44례노년협암환자행협암근치술화경림파청소술후동기분별응용해하SIMF（n＝19）화FSG（n＝25）수복협부결손。비교량조환자술후협부외형회복정도、개구수한정도、어음공능、저작공능등정황。결과 SIM F조1례출현피도배사，청창후발현기판혈운량호，기여전부성활，피판이식성공솔94．7％（18/19），공구직접랍롱봉합FSG조적이식성공솔위100．0％（25/25）；SIMF조소유병례술후12개월수방，협부외형회복정도、장구수한정도、어음공능、저작공능균우우FSG조（ P＜0．05）。FSG조유1례술후5월출현원발조복발。량조간재복발전이정황방면차이무통계학의의（P＞0．05）。결론해하SIMF괄합노년환자협암절제술후조직결손적수복，제고료환자술후생존질량，구유교호적림상응용전경。
Objective To observe and evaluate the clinical effect of submental island myocutaneous flap(SIMF) and free skin graft(FSG) for the reconstruction of buccal defect resulted from the buccal carcinomas .Methods Forty-four aged aging patients di-agnosed with the buccal carcinomas were operated by the total dissection of primary tumor and selective neck dissection and recon-structed simultaneously with SIMF(19 cases) and FSG(25 cases) .The degree of postoperative cheek shape ,limitation of mouth o-pening ,speech sound ,and function of chewing were observed and analyzed .Results Eighteen SIMFs were completely survived .The residual muscle flap had a good blood supply after the debridement of skin island in one case ,the successful rate of flaps was 94 .7%(18/19) while 100% (25/25) .The donor site of SIMF was sutured directly .Follow-up was taken in 12 months for all patients .In SIMF group ,the degree of postoperative cheek shape ,limitation of mouth opening ,speech sound ,and function of chewing were bet-ter than those of FSG group in FSG group(P<0 .05) .There was no significant difference between 2 groups in the field of recur-rence and metastasis although the recurrence adjacent to the primary tumor had happened in FSG group in 5 months after operation (P>0 .05) .Conclusion The submental island flap is an excellent choice for the reconstruction of cheek defects in aging patients af-ter resection of buccal carcinoma .With acceptable cosmetic ,functional results and reasonable oncological saftety ,SIMF has a prom-ising prospect in head and neck surgery .