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頁籤選單縮合
題名 | Local Application of Urokinase for Free Flap Salvage after Head and Neck Reconstruction: Analysis of 34 Cases=血栓溶解劑在挽救自由皮瓣上的應用:34例血管探查的經驗 |
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作者姓名(中文) | 黃傑慧; 陳明庭; 鄭乃禎; 戴浩志; 洪學義; 湯月碧; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 20:4 2011.12[民100.12] |
頁次 | 頁288-295 |
分類號 | 416.413 |
關鍵詞 | 血栓溶解劑; 自由皮瓣; 頭頸部重建; Head and neck; Thrombolysis; Flap salvage; Microsurgery; Urokinase; |
語文 | 英文(English) |
中文摘要 | 背景:目前顯微自由皮瓣移植手術已經成為頭頸部重建的重要方式,然而術後血管栓塞導致皮瓣壞死手術失敗仍然是從事顯微手術的外科醫師心中永遠的壓力來源。儘管我們盡最大的努力避免皮瓣失敗,有時仍會遇到血管栓塞無法輕易解決的狀況。目的及目標:這個回溯性研究的目標在於分析以顯微手術進行頭頸部重建後血管探查及自由皮瓣挽救的經驗,重點探討血栓溶解劑的使用。材料及方法:從2009年1月至2011年4月,在台大醫院接受頭頸部腫瘤切除合併自由皮瓣重建手術的345病例中有34個病患因術後皮瓣血循異常而接受緊急血管探查手術,我們根據血栓形成的位置在動脈或靜脈的不同表現將病患分為4組,根據使用血栓溶解劑Urokinase與否來分析最後皮瓣存活率。結果:整體皮瓣挽救的成功率是85%,在34例中有29個皮瓣被成功地重新建立血循。在成功救回的29例中,只有4例後來發生局部皮瓣壞死。在靜脈血栓的這組病例中,大多數患者(15例中有11例)接受urokinase治療,且皮瓣存活率是100%;而在動脈血栓這組中的5例患者有4例使用urokinase,其中有半數皮瓣(4例中的2例)存活。使用Urokinase的18病例中,並沒有發生血腫、流血不止、甚至顱內出血的併發症。結論:我們的結果顯示術中使用血栓溶解劑對於整體自由皮瓣挽救的成功率並沒有明顯的提升,熟練的手術技巧、好的手術計畫、精確的判斷、和及早偵測皮瓣血循異常才是自由皮瓣手術成功重要的因素。面對皮瓣血栓產生而難以清除的困難時,我們認為術中使用血栓溶解劑仍然是可以使用的輔助方法。 |
英文摘要 | Background:Nowadays microsurgical free tissue transfer plays an important role in head and neck reconstruction, but the postoperative vascular thrombosis is still a nightmare for every microsurgeon. Despite the effort to avoid flap failure, sometimes we may still face the condition of the severe vascular thrombosis that cannot be easily resolved.Aim and Objectives:The aim of this study is to analyze the results of flap salvage after microvascular head and neck reconstruction, with the emphasis on using the thrombolytic agenturokinase.Material and Methods:From January 2009 to April 2011, 34 out of 345 cases having head and neck reconstruction with free flap transfer were re-explored due to postoperative vascular compromise. All cases were divided into 4 groups according to the presence of thrombi in the pedicle artery or vein, and the salvage results were further analyzed based on the use of urokinase or not.Result:Overall flap salvage rate was 85%, with 29 out of 34 free flaps successfully revascularized. Among the rescued flaps, only 4 flaps developed partial necrosis. In the group of venous thrombosis, most patients (11 out of 15) were treated with urokinase, and the salvage rate was up to 100%. In the arterial thrombosis group, 4 out of 5 were treated with Urokinase, and half of the flaps (2 out of 4) survived. None of the 18 cases, who received urokinase treatment, developed complications, such as hematoma, unstoppable bleeding, and intra-cranial hemorrhage.Conclusion:Our results demonstrated that intra-operative administration of thrombolytic agent did not increase the salvage rate of free flap. Proficient surgical technique, good operative design, precise judgment, and early detection of postoperative vascular compromise are the key factors of free flap success. The local application of urokinase intra-operatively can serve as a useful and safe adjunct upon vascular exploration for the thrombosis which was difficult to deal with. |
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