摘要
目的探讨口腔颌面部游离组织瓣血管危象的危险因素。方法对中山大学光华口腔医学院·附属口腔医院颌面外科2000年12月至2013年10月完成游离组织瓣移植手术的451例患者临床资料进行回顾性研究,采用SPSS17.0统计软件对可能造成血管危象的因素分布进行单因素分析(t和χ2检验),对于有统计学意义者(P<0.05)进行多因素logistic回归分析。结果本组患者均为单块组织瓣修复,共采用8种游离组织瓣,合计451块,包括前臂皮瓣、腓骨肌皮瓣、股前外侧皮瓣、上臂外侧皮瓣、腹直肌皮瓣(脐旁皮瓣)、髂骨肌皮瓣、背阔肌皮瓣、股前内侧皮瓣。术后43例发生危象,占9.53%,以静脉危象为主(33/43)。其中对40例行手术探查,22例抢救成功,占55%。单因素分析显示静脉吻合方式以及术前放疗有统计学意义(P<0.05)。经多因素logistic回归分析,只有静脉吻合方式有统计学意义(P<0.05,OR值为3.633)。结论游离组织瓣一旦出现危象,应积极手术探查,可获得较高的抢救成功率。静脉端侧吻合是游离组织瓣发生血管危象的危险因素。
Objective To investigate the risk factors for vascular crisis in free flaps reconstruction of oral and maxillofacial defects. Methods Clinical data of 451 free revascularized flaps in 451 patients performed in our department from December 2000 to October 2013 were reviewed. Statistical analysis was done using SPSS statistical software （SPSS for Windows Version17.0）. Univariate statistical analysis was performed to analyze the factors predicting vessel crisis using χ2 and 2-tailed t test methods. For those factors showing statistical significance on univariate analysis （P〈0.05）,multivariate logistical regression analysis was then undertaken. Results Forty-three flaps developed vascular crisis （9.53%）, most of which were caused by venous crisis （33/43）. Forty flaps were explored with 22 flaps successfully salvaged, and the success rate was as high as 55%. Univariate analysis showed that end-to-side venous anastomosis and preoperative radiotherapy were of statistical significance （P〈0.05）, but multivariate logistic regression analysis showed that only end-to-side venous anastomosis was of statistical significance. Conclusion The surgical exploration should be done as soon as possible after vascular crisis occurs to get a higher success rate. End-to-side venous anastomosis may be a risk factor in free tissue transfer.
出处
《中国实用口腔科杂志》
CAS
2014年第3期160-163,167,共5页
Chinese Journal of Practical Stomatology
基金
中山大学临床医学研究5010计划(2010018)
