CAJ | 학술논문

目的探讨头颈肿瘤游离组织瓣移植术后血管危象的处理方法.方法 2010年1月至2013年12月共完成259例头颈部肿瘤患者游离组织瓣移植术,其中股前外侧皮瓣89例,前臂皮瓣48例,腓骨46例,空肠64例,腹壁下动脉穿支皮瓣5例,游离背阔肌皮瓣5例,上臂外侧皮瓣、股内侧皮瓣各1例.游离组织瓣移植术后第1天,组织瓣每小时观察1次;移植术后第2～3天,组织瓣每2h观察1次;移植术3d后,组织瓣每4h观察1次.分析血管危象的发生情况和处理方法.结果 259例患者中,有21例患者出现游离组织瓣血管危象,血管危象发生率为8.1％ (21/259).其中男性15例,女性6例,年龄为17～68岁,平均年龄54.8岁;发现血管危象的时间为术后3～432 h,平均发生时间为100.8 h.21例血管危象患者中,空肠血管危象7例,皮瓣血管危象14例.21例血管危象患者中,手术挽救成功7例(33.3％),其中在72 h内入室探查11例,挽救成功6例,挽救成功率为54.5％;超过72 h入室探查10例,挽救成功1例,挽救成功率为10.0％,差异有统计学意义(P=0.043).结论早期发现游离组织瓣血管危象可有效提高组织瓣的挽救成功率,避免其坏死带来的严重后果.
목적 탐토두경종류유리조직판이식술후혈관위상적처리방법.방법 2010년1월지2013년12월공완성259례두경부종류환자유리조직판이식술,기중고전외측피판89례,전비피판48례,비골46례,공장64례,복벽하동맥천지피판5례,유리배활기피판5례,상비외측피판、고내측피판각1례.유리조직판이식술후제1천,조직판매소시관찰1차;이식술후제2～3천,조직판매2h관찰1차;이식술3d후,조직판매4h관찰1차.분석혈관위상적발생정황화처리방법.결과 259례환자중,유21례환자출현유리조직판혈관위상,혈관위상발생솔위8.1％ (21/259).기중남성15례,녀성6례,년령위17～68세,평균년령54.8세;발현혈관위상적시간위술후3～432 h,평균발생시간위100.8 h.21례혈관위상환자중,공장혈관위상7례,피판혈관위상14례.21례혈관위상환자중,수술만구성공7례(33.3％),기중재72 h내입실탐사11례,만구성공6례,만구성공솔위54.5％;초과72 h입실탐사10례,만구성공1례,만구성공솔위10.0％,차이유통계학의의(P=0.043).결론 조기발현유리조직판혈관위상가유효제고조직판적만구성공솔,피면기배사대래적엄중후과.
Objective To discuss the management of vascular crisis of free flaps after reconstruction of head and neck defects caused by tumor resection.Methods A total of 259 cases of free flap reconstruction performed in the Cancer Hospital of Chinese Academy of Medical Sciences from 2010 to 2013 were retrospectively analyzed, including 89 cases of anterolateral thigh flaps, 48 cases of radial forearm flaps, 46 free fibula flaps, 5 cases of inferior epigastric artery perforator flaps, 5 cases of free latissimus dorsi flaps, one case of lateral arm flap, and one case of medial femoral flap.The surveillance frequency of free flaps was q1h on post-operative day (POD) 1, q2h on POD 2 and 3, and q4h after POD 3.Vascular crises were reviewed for analysis.Results The incidence rate of vascular crisis was 8.1％ (21/259), with 15 males and 6 females.The average age was 54.8 years old (17-68), and the average time of vascular crisis was t00.8 h post-operation (3-432).There were 7 cases of free jejunum flaps and 14 dermal free flaps-Seven of these 21 cases with vascular crisis were rescued by surgery.The success rate of salvage surgery within 72 hours from the primary operation was 54.5％ (6/11), significantly higher than that of salvage surgery performed later than 72 hours from primary operation (10.0％, 1/10, P =0.043).There were 14 cases of flap necrosis, two of which died of local infection.Conclusion Early detection of vascular crisis can effectively improve the success rate of salvage, so as to avoid the serious consequences caused by free flap necrosis.