CAJ | 학술논문

目的回顾分析颅颌面联合切除术后缺损修复的效果. 方法 2005年1月至2011年1月,共行颅颌面联合切除术治疗累及颅底的口腔颌面-头颈部肿瘤88例,按颅颌面缺损冠状位上硬脑膜、颅底骨和面部组织缺损的不同类型,选择相应的修复方法.硬脑膜无缺损者(37例)无需修复,对于可直接缝合的硬脑膜缺损(25例)直接缝合;对于无法直接缝合的硬脑膜缺损(26例)采用大腿阔筋膜(2例)、颞肌筋膜(2例)、颅骨骨膜(1例)或人工硬膜补片(21例)修复.58例颅底骨缺损分别采用钛网(57例)、游离髂骨(1例)、颅骨(2例)或Medpor(1例)进行修复.面部软、硬组织的局限性缺损选用邻近颞肌系统瓣(36例)、胸锁乳突肌瓣(6例)以及翼内肌瓣(2例)修复;面部软、硬组织的广泛缺损则选用背阔肌肌皮瓣(26例)、胸大肌肌皮瓣(12例)、股前外侧穿支皮瓣(5例)、股前内侧穿支皮瓣(1例)等血管化游离组织瓣进行修复. 结果组织瓣转移的成功率为100％,术后4例出现脑脊液漏,2例发生局部感染,经保守治疗后治愈;2例于术后7～10d发生颅内感染,经积极对症处理无效而死亡.总并发症率为9.1％,死亡率为2.3％. 结论硬脑膜的水密修复、颅底的骨性重建和血供良好的组织瓣覆盖能够成功地重建颅颌面联合切除术后的缺损.应根据缺损的程度和解剖部位来选择合适的局部组织瓣或游离组织瓣移植修复.
목적 회고분석로합면연합절제술후결손수복적효과. 방법 2005년1월지2011년1월,공행로합면연합절제술치료루급로저적구강합면-두경부종류88례,안로합면결손관상위상경뇌막、로저골화면부조직결손적불동류형,선택상응적수복방법.경뇌막무결손자(37례)무수수복,대우가직접봉합적경뇌막결손(25례)직접봉합;대우무법직접봉합적경뇌막결손(26례)채용대퇴활근막(2례)、섭기근막(2례)、로골골막(1례)혹인공경막보편(21례)수복.58례로저골결손분별채용태망(57례)、유리가골(1례)、로골(2례)혹Medpor(1례)진행수복.면부연、경조직적국한성결손선용린근섭기계통판(36례)、흉쇄유돌기판(6례)이급익내기판(2례)수복;면부연、경조직적엄범결손칙선용배활기기피판(26례)、흉대기기피판(12례)、고전외측천지피판(5례)、고전내측천지피판(1례)등혈관화유리조직판진행수복. 결과 조직판전이적성공솔위100％,술후4례출현뇌척액루,2례발생국부감염,경보수치료후치유;2례우술후7～10d발생로내감염,경적겁대증처리무효이사망.총병발증솔위9.1％,사망솔위2.3％. 결론 경뇌막적수밀수복、로저적골성중건화혈공량호적조직판복개능구성공지중건로합면연합절제술후적결손.응근거결손적정도화해부부위래선택합괄적국부조직판혹유리조직판이식수복.
Objective To review our patients who underwent reconstruction of the defect after combined cranio-maxillo-facial resection in recent years.Methods From January,2005 to January,2011,88 patients underwent reconstruction of the defect after combined cranio-maxillo-facial resection.Different reconstructive techniques were used according to the defect classifications in dura,skull base bone,and facial tissues.For dural defects,no repair (37 cases),primary closure (25 cases),and dural repair (26 cases) were performed,respectively.Dural repair materials included thigh fascia lata (2 cases),temporalis fascia (2 cases),pericranium (1 case) and artificial dural patch (21 cases).Bone reconstruction of the skull base were performed in 61 patients with titanium mesh (57 cases),free iliac bone graft (1 case),free cranial bone graft (2 cases) and Medpor (1 case),respectively.Limited facial soft and hard tissue defects in 44 patients were reconstructed with temporalis system of flaps (36 cases),sternocleidomastoid myocutaneous flap (6 cases),and pterygoid muscle flap (2 cases),respectively.Extensive facial soft and hard tissue defects in 44 patients were reconstructed with free latissimus dorsi myocutaneous flap (26 cases),free pectoralis major myocutaneous flap (12 cases),free anterolateral thigh perforator flap (5 cases cases) and free anteromedial thigh perforator flap (1 case),respectively.Results The overall success rate of 88 flaps was 100％.Cerebrospinal fluid leak was found in 4 patients,wound infection was found in 2 patients,intracranial infection was found in 2 patients,respectively.Six patients with cerebrospinal fluid leak or wound infection were cured by conservative treatment.Two patients with intracranial infection were dead although they underwent salvage surgery.Overall rate of complications was 9.1％,dead rate was 2.3％.Conclusion Successful reconstruction of the defect after combined cranio-maxillo-facial resection can be achieved by watertight dural repair,bone reconstruction of the skull base and well-vascularized tissue covered.Regional flap and free tissue transfer are both preferred reconstructive technique depending on the anatomic site and the extent of the defect.