摘要
Abstract
Objective To explore the efficacy of mastoid muscle flap,clinical commonly used free flap and submental island flap in the repair of oral cancer patients and the influence on swallowing function,phonetic function and wound aesthetics.Methods 90 patients with postoperative defect repair of oral cancer treated in the hospital from June 2019 to December 2022 were retrospectively selected as the study subjects.According to the surgical methods,they were divided into mastoid group(n=30,repaired with sternocleidomastoid muscle flap),free group(n=33,repaired with free forearm flap)and submental group(n=27,repaired with submental island flap).The perioperative indicators(operation time,flap area,intraoperative blood loss,postoperative drainage volume,hospital stay)were compared among the three groups.The flap repair effect[survival(complete survival,partial necrosis,complete necrosis,flap survival rate),scar contracture,tumor safety(recurrence/metastasis)]was reviewed at 3 months after operation.At 12 months after operation,the swallowing function[clinical nursing swallowing assessment tool(CNSAT)],language function(Chinese speech intelligibility test word list)and wound aesthetic satisfaction[Vancouver scar scale(VSS)]were compared among the three groups.Results The operation time and flap area of the mastoid group were significantly lower than those of the submental group and the free group(P＜0.05),and the above indexes of the submental group were significantly lower than those of the free group(P＜0.05).The intraoperative blood loss,postoperative drainage volume and hospital stay of the submental group were significantly lower than those of the submental group and the free group(P＜0.05).The intraoperative blood loss and postoperative drainage volume of the free group were significantly lower than those of the mastoid group(P＜0.05),and the hospital stay was significantly longer than that of the mastoid group(P＜0.05).The flap survival rates of the mastoid group,the free group and the submental group were 76.67%,69.70%and 96.30%respectively(P＜0.05).The flap survival rate of the submental group was significantly higher than the free group(P＜0.05).The incidence of scar spasm in the submental group was significantly lower than that in the free group(P＜0.05),but there was no significant difference in the tumor safety among the three groups(P＞0.05).At 3,6 and 12 months after operation,the swallowing function score of the three groups was gradually decreased while the phonetic function score was gradually increased,and there were significant differences at different time points within the groups(P＜0.05).At 3 and 6 months after surgery,the swallowing function,phonetic function revealed statistically significant differences(P＜0.05),and the scores in the submental group were significantly lower than the other two groups(P＜0.05),and the scores in the free group were significantly higher than the mastoid group(P＜0.05).At 12 months after operation,the scores of pigmentation,scar thickness,vascular distribution and flexibility of VSS of the submental group were significantly lower than those of the submental group and the free group(P＜0.05),and the scores of the free group were significantly higher than those of the mastoid group(P＜0.05).Conclusion Compared with the free forearm flap,sternocleidomastoid flap and submental island flap has the characteristics of small trauma,no need for vascular anastomosis and high flap survival rate.Submental Island Flap has a higher repair aesthetics.It is recommended to choose the best repair and treatment methods according to the actual situation of patients..关键词
口腔癌/缺损修复/乳突肌瓣/游离皮瓣/颏下岛状瓣/疗效/吞咽功能/语音功能/美观度Key words
oral cancer/defect repair/mastoid muscle flap/free flap/submental island flap/efficacy/swallowing function/phonetic function/aesthetics分类
医药卫生
