余晓宁　蔡洁琛

【摘要】 目的：探讨影响口腔颌面部肿瘤术后游离皮瓣存活的危险因素，为减少血管危象、提高游离皮瓣术后存活率提供参考。方法：选取2014年1月-2019年1月笔者所在医院口腔颌面外科收治的208例口腔颌面部肿瘤手术患者为研究对象，依据术后游离皮瓣存活情况将入选患者分为两组。A组191例，术后游离皮瓣成功存活;B组17例，术后游离皮瓣出现血管危象。收集两组临床资料及血生化指标进行比较，Logistic回归分析影响游离皮瓣存活的危险因素。结果：A组糖尿病4例（23.53%），术前放疗4例（23.53%），口腔感染0例，血纤维蛋白原为（2.98±0.36）mg/L，与B组比较差异均有统计学意义（P<0.05）。Logistic回归分析示，糖尿病、术前放疗、口腔感染、血FIB升高是影響口腔颌面部肿瘤术后游离皮瓣存活的独立危险因素。结论：影响口腔颌面部肿瘤术后游离皮瓣存活的因素众多，加强术前准备，合理控制血糖，规范术中操作，严格遵循无菌化原则，有助于减少血管危象，提高游离皮瓣存活率。

【关键词】 口腔颌面部肿瘤手术; 游离皮瓣; 存活; 血管危象; 危险因素

doi：10.14033/j.cnki.cfmr.2019.19.080 文献标识码 B 文章编号 1674-6805（2019）19-0-03

Analysis of Related Factors of Free Flap Survival after Oral and Maxillofacial Tumors/YU Xiaoning，CAI Jiechen.//Chinese and Foreign Medical Research，2019，17（19）：-179

【Abstract】 Objective：To investigate the risk factors of free flap survival after oral and maxillofacial tumor surgery，and to provide reference for reducing vascular crisis and improving the survival rate of free flap.Method：A total of 208 patients with oral and maxillofacial tumors admitted to our hospital from January 2014 to January 2019 were enrolled.The patients were divided into two groups according to the survival of free flaps.In group A，191 patients had successful free flap after operation.In group B，vascular crisis occurred in 17 patients with free flap after operation.The clinical data and blood biochemical indexes of the two groups were collected for comparison.Logistic regression analysis was used to analyze the risk factors affecting the survival of free flaps.Result：In group A，there were 4 cases of diabetes（23.53%），4 cases of preoperative radiotherapy（23.53%），0 case of oral infection，and fibrinogen was （2.98±0.36）mg/L，and compared with the group B，the differences were statistically significant（P<0.05）.Logistic regression analysis showed that hyperglycemia，preoperative radiotherapy，oral infection and elevated blood FIB were independent risk factors for the survival of free flap after oral and maxillofacial tumor surgery.Conclusion：There are many factors influencing the survival of free flap after oral and maxillofacial tumor surgery.Strengthen preoperative preparation，rationally control blood sugar，standardize intraoperative operation，strictly follow the principle of aseptic，help reduce vascular crisis and improve the survival rate of free flap.

【Key words】 Oral and maxillofacial tumor surgery; Free flap; Survival; Vascular crisis; Risk factors

First-authors address：Huizhou First Peoples Hospital，Huizhou 516000，China