吴文科 胡革 朱镇华

[摘要]目的：探讨游离股前外侧皮瓣在全舌体或近全舌体术后缺损修复重建中的应用。方法：收集笔者科室2017年6月-2020年5月应用股前外侧游离皮瓣修复重建全舌体切除或近全舌切除患者资料，进行回顾性分析，共7例患者，评估股前外侧皮瓣重建方式、移植成功率、术后功能恢复情况以及术后并发症发生情况。结果：7例皮瓣均成活，皮瓣大小10cm×7cm～18cm×8cm，术后1例患者颏下伤口未愈合，所有患者均能进食半流质食物或软食，6例患者顺利拔除气管套管，语音恢复基本满意。结论：股前外侧皮瓣“自然成形”重建全舌体缺损或近全舌缺损的方法，简单、容易掌握，术后功能恢复满意，并发症少，供区损伤小，是一种不错的修复方法。

[关键词]股前外侧皮瓣;舌癌;近全舌缺损;修复外科手术;术后缺损;缺损修复

[中图分类号]R739.86    [文献标志码]A    [文章编号]1008-6455（2021）04-0071-04

Application of Free Anterolateral Thigh Flap in Reconstruction of Defects after Total Mobile Tongue or Subtotal Tongue Resections

WU Wen-ke，HU Ge，ZHU Zhen-hua

（Department of Otorhinolaryngology Head and Neck Surgery，the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine，Changsha 410007，Hunan，China）

Abstract： Objective  To explore the application of free anterolateral thigh flap in the reconstruction of defect after total or subtotal tongue operation. Methods  From June 2017 to May 2020， we collected the data of patients who underwent total mobile tongue resection or subtotal tongue resection by using anterolateral free thigh flap in our department， and analyzed retrospectively. There were 7 patients. We evaluated the reconstruction method of anterolateral thigh flap， the success rate of transplantation， the recovery of postoperative function and the occurrence of postoperative complications. Results  All the flaps survived， the flap size was 10cm×7cm～18cm×8cm. One patient's submental wound was not healed after the operation. All the patients were able to eat semi liquid food or soft food. Six patients successfully removed the tracheal tube， and the voice recovery was basically satisfactory. Conclusion  The method of “natural shaping” of anterolateral thigh flap to reconstruct the defect of the total mobile tongue or the subtotal tongue is simple and easy to master. It is a good method with satisfactory functional recovery， less complications and less damage to the donor area.

Key words： anterolateral thigh flap; tongue neoplasms; subtotal tongue glossectomy; repair surgery; postoperative defect; defect repair

舌癌是口腔中最常见的恶性肿瘤，其恶性程度高，侵袭性强，患者就诊时常常是局晚期。临床可表现为伸舌受限、吞咽困难、言语不清等。局晚期舌癌预后欠佳，研究报道局晚期舌癌5年生存率约为21%～50%[1]。全舌体切除或近全舌切除是局晚期舌癌治疗的一种重要手术方式，可以最大限度地切除晚期舌癌或口底癌，但同时也是舌功能重建的巨大挑战。传统治疗上采用带蒂皮瓣[2]（胸三角皮瓣、额瓣、斜方肌瓣和胸大肌瓣等）来进行修复重建，但患者语音及吞咽功能重建受到限制。随着显微外科学的发展，股前外侧皮瓣和腹直肌皮瓣[3-4]更常用于全舌切除重建，充足的组织量以及更小的供区损伤也给患者功能修復带来更多的希望。……