摘要目的 探讨颏下岛状瓣在口腔癌切除术后修复中的应用效果.方法 随机抽取2015年12月至2018年6月山西省肿瘤医院收治的经手术病理确诊的鳞状细胞癌患者33例,其中无颈淋巴结转移(cN0)20例,行局部肿瘤扩大切除术+颏下岛状皮瓣修复;颈淋巴结转移(cN+)13例,行肿瘤扩大切除术+颈部淋巴结清扫+颏下岛状皮瓣修复+术后放疗.采用Kaplan-Meier绘制生存曲线,分析术后2年cN0与cN+患者生存情况,统计患者切口愈合、颏下岛状皮瓣存活、术后口腔外形及功能情况.结果 33例患者术后切口均一期愈合,颏下皮瓣存活率为93.94％(31/33),颏下岛状皮瓣面积为4.0 cm×2.5 cm～8.0 cm×4.0 cm,颏下皮瓣为患者提供了较好的面部外形,术后6个月后内口皮瓣生为口腔黏膜,男性患者皮瓣胡须脱落,皮瓣颜色与周围皮肤相似.随访2年,20例cN0患者中,失访3例,死亡3例,2年死亡率为15.00％;13例cN+患者中,失访2例,死亡3例,病死率为23.08％.有颈淋巴结转移、无颈淋巴结转移患者2年生存曲线比较,差异未见统计学意义(χ2=0.33,P>0.05).结论 颏下岛状皮瓣修复口腔癌术后颌面部组织,一期修复皮瓣存活率高,切口美观度良好,手术简单,但应严格掌握手术适应证.

abstractsObjective To investigate the efficacy of submental island flap in the postoperative repair oforal cancer resection.Methods A total of33 patients with squamous cell carcinoma diagnosed by surgery and pathology from December 2015 to June 2018 in Shanxi Provincial Cancer Hospital were randomly selected.Among them,20 patients without cervical lymph node metastasis (cN0)underwent local tumor enlargement resection +submental island flap repair;13 patients with cervical lymph node metastasis (cN +)underwent extended tumor resection +cervical lymph node dissection +submental island flap repair +postoperative radiotherapy.Survival curves were drawn by Kaplan-Meier to analyze the survival of patients with cN0 and cN +2 years after operation.The incision healing,survival of the infraorbital island flap,postoperative oral shape and function were analyzed.Results All the incisions healed in 33 cases.The survival rate of the inferior temporal flap was 93. 94％(31/33 ),and the area of the inferior island flap was 4. 0 cm ×2. 5 cm to 8. 0 cm ×4. 0 cm,and the submental flap provided a better facial shape.The internal opening flap was found to be oral mucosa 6 months after surgery,and the flap showed a beard falling off and the color turned rosy and similar flap color with the surrounding skin in male patients.During 2 years of follow-up,there were 3 cases lost to follow-up and 3 cases of death among the 20 patients with cNo;and the 2-year mortality was 15. 00％.There were 2 cases losted follow-up and 3 cases of death among the 13 patients with cN +;and the mortality rate was 23. 08％. There was no significant difference in the 2-year survival curve of patients with or without cervical lymph node metastasis (χ2 =0.33,P >0.05 ).Conclusions Submental island flap repair has good application value in patients after oral cancer resection.The survival rate of the first-stage repair flap is high,and the operation is simple.However,the surgical indications should be strictly controlled.