明华伟 何芸 张兴安 韩新生 王华东 谭小尧

[摘要]目的：探讨CTA（CT血管造影）对指导游离股前外侧肌皮瓣制备的辅助价值及该皮瓣在舌癌术后缺损修复中的临床效果。方法：对17例明确诊断为舌鳞形细胞癌的患者，术前采用CTA辅助定位旋股外侧动脉降支的穿支血管，选取以该穿支血管为蒂的股前外侧肌皮瓣游离移植修复舌癌术后软组织缺损。结果：所有患者术前CTA辅助定位穿支血管的皮瓣制备在术中按计划均获成功，游离移植肌皮瓣全部存活。术后随访6～36个月，患者舌体形态、功能恢复良好，无明显吞咽及言语功能障碍，局部未见肿瘤复发，供瓣肢无功能障碍。其中1例（T4N2M0）于术后12个月合并肝、肺转移后死亡。结论：CTA辅助定位旋股外侧动脉穿支血管的方法可靠、实用，游离股前外侧肌皮瓣是修复舌癌术后软组织缺损较为理想的选择。

[关键词]CT血管造影（CTA）;股前外侧肌皮瓣;舌癌;游离皮瓣;修复重建

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2019）02-0023-04

Abstract： Objective  The aim of the study was to investigate the auxiliary value of computed tomography angiography（CTA） in assisting the preparation of free anterolateral thigh myocutaneous flap（ALTMF） and the clinical effect of ALTMF for the reconstruction of postoperative defects after radical resection of tongue carcinoma. Methods  CTA were used to locate the perforating vessel of lateral circumflex femoral artery （LCFA） in all cases who were diagnosed as tongue carcinoma， postoperative defects were reconstructed with the flap which depended on the perforating vessel of LCFA. Results  The preparation of preoperative CTA achieved success as plan and survived completely in all cases. All patients were followed up 6-36 months， There was no functional morbidity in donor sites and local recurrence happened. The shape and function of all cases were both satisfactory in reconstructed tongue. Only one case（T4N2M0） died of liver and lung metastasis 12 months after operation. Conclusion  The method of CTA assisted to locate the perforating vessel of ALTMF is reliable and practical. The ALTMF is an ideal choice for the reconstruction of postoperative defects after radical resection of tongue carcinoma.

Key words： computed tomography angiography; anterolateral thigh myocutaneous flap; tongue carcinoma; free flap; reconstruction

舌癌是最常见的口腔癌，目前仍采用原发灶扩大切除联合颈淋巴清扫达到根治目的。为提高患者术后生活质量，尽可能恢复舌外形及功能，各种游离组织瓣正不断被用于术后遗留创面的修复重建[1]。股前外侧肌皮瓣因其相较于传统游离肌皮瓣的独特优势，现已成为口腔颌面部软组织缺损修复重建的常用皮瓣[2-3]。但是股前外侧肌皮瓣属于穿支皮瓣，其穿支血管解剖变异大[4-5]，术前对其穿支血管定位是获得该穿支皮瓣移植成功的关键环节。……