摘要
目的分析游离皮瓣移植术发生皮瓣危象及坏死的原因，找出预防和解决的方法，提高皮瓣移植的成功率。方法回顾性分析2010年10月至2014年4月850例应用游离皮瓣修复的患者的临床资料，分析皮瓣危象发生及坏死的原因。对患者的一般资料及手术医生的年资及吻合静脉数等影响预后的因素进行单因素分析，多因素分析采用Logistic回归分析。结果850例患者中12例术中取用皮瓣时即发现血运欠佳，换用其他部位皮瓣。73例术后出现血管危象，31例经过皮瓣探查、针刺皮瓣、低分子肝素钙皮下注射等方法成功抢救，最终失败42例，皮瓣移植成功率为95．1％（808／850）；多因素分析显示肥胖、吸烟、放疗、低年资手术医师是导致皮瓣坏死的危险因素（P值均〈0．05）；而年龄、高血压及糖尿病在本组病例中差异并无统计学意义（P〉0．05）；吻合两根静脉比吻合1根静脉具有更高的成功率（P〈0．05）。结论选用合适的皮瓣、仔细地进行解剖、精心地制备皮瓣、认真地吻合血管、严格止血、注重围手术期的处理，能够最大程度地降低皮瓣移植的坏死率。皮瓣存在两根静脉的情况下，建议将两根静脉都予以吻合，以提高皮瓣的存活率。老年患者、高血压及糖尿病并不是游离皮瓣移植的禁忌证。
Objective To analyze the causes of the vascular crisis and necrosis of free flaps used for reconstruction of defects following head and neck cancer resection and the managements of these issues. Methods A total of 850 cases with head and neck tumors who underwent free flap reconstruction from October 2010 to April 2014 were studied retrospectively. The risks for vascular crisis and necrosis were analyzed with one-factor analysis and multivariate analysis. Results The total success rate of 95. 1% （808/850） for the free flap reconstruction was obtained. Twelve flaps due to poor blood supply indicated during operation were replaced by other free flaps. Among 73 flaps with vascular crisis, 31 flaps were salvaged by surgical exploration and subcutaneous injection of low molecular heparin calcium. Obesity, smoking, preoperative radiotherapy and surgeon＇s experience, rather than age, hypertension and diabetes, were the risk factors of skin flap necrosis. Two-vein anastomosis had a higher success rate than one-vein anastomosis. Conclusions The necrosis rate of free flaps can be reduced by the choice of suitable flaps, subtly preparation of flaps, carefully vascular anastomosis, and prompt perioperative managements. The twovein anastomosis is recommended. Diabetes, hypertension and elderly patients are not the contraindications for free flap reconstruction.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2015年第2期118-122,共5页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
湖南省自然科学基金（12JJ4088）
湖南省卫生厅一般项目（B2012-100）
