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頁籤選單縮合
題名 | 影響自由皮瓣在頭頸部重建成功率因子之探討=Analysis of Factors Influencing Success Rates of Free Flaps in Head and Neck Reconstruction |
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作者 | 徐偉凱; 白馨; 林廷宣; 蘇偉嘉; 李芳輝; 羅正興; Hsu, David Wei-kai; Pai, Hsin; Lin, Ting-shung; Su, Wei-chia; Lee, Fang-hui; Lo, Cheng-hsing; |
期刊 | 臺灣口腔顎面外科學會雜誌 |
出版日期 | 20160300 |
卷期 | 27:1 2016.03[民105.03] |
頁次 | 頁1-11 |
分類號 | 416.95 |
語文 | chi |
關鍵詞 | 自由皮瓣重建; 頭頸部重建; 自由皮瓣成功率; Free flap reconstruction; Free flap success rate; Head and neck reconstruction; |
中文摘要 | 由於自由皮瓣的高成功率,顯微手術已成爲頭頸部缺損重建之標準術式。儘管有高的成功率,仍有相當多的因子會影響皮瓣的存活與否。此篇報告將提出一系列因子,分析其與自由皮瓣成功率之間的關係。我們回溯性回顧從2001年2月至2011年10月連續兩百零五位病人,共261片皮瓣。使用自由皮瓣的案例主要爲頭頸部腫瘤切除後之重建,其餘的有下顎骨放射線骨壞死與嚴重張口受限等案例。而分析的因子包括有病人的性別、年齡、糖尿病、抽菸與否、選擇的受區血管、接合的方式、使用靜脈移植、術前是否有接受放射線治療、再探查的時機、一組或兩組手術團隊、惡性腫瘤的期別、位置及是否爲復發個案等。統計方法在單變數統計分析使用卡方檢驗與費雪精確檢驗,而多變數分析使用多變相邏辑式回歸。結果顯示自由皮瓣的成功率爲97.7%而再探查的機率爲22.6%。最常使用的受區動脈爲上甲狀腺動脈、橫頸動脈與顏面動脈;靜脈爲外頸靜脈、内頸靜脈、與上甲狀腺靜脈。受區血管的選擇不會顯著的影響皮瓣成功率。所有分析的因子只有再探查的時間具有統計學上的意義。將需再探查的皮瓣做分析,成功拯救的那組平均再探查時間爲術後10.8小時,而失敗那組爲術後26.7小時。頭頸部的血管皆可作爲受區血管的選擇,重點是能尋找一通暢與有力的金管作接合。術後密集的檢查皮瓣金循與即時的再探查是皮瓣成功的重要因素。 |
英文摘要 | Background: Free flap transfers have a high success rate and have become a standard procedure for extensive head and neck reconstruction. However, for a micro-vascular reconstruction, many factors still affect the outcome. In this study, a set of factors was evaluated to determine whether they influenced the success rate of the free flap transfers. Method: Retrospectively, we reviewed 205 patients with 261 free flaps in head and neck reconstruction in St. Martin De Porres Hospital from February 2001 to October 2011. The major reasons for reconstruction were tumor ablation, and the others were for reconstruction plate exposure or osteoradionecrosis after radiotherapy in head and neck regions. The factors which were analyzed included patient's age, diabetes mellitus, smoking, radiotherapy, stage of disease, selection of vessels, method of anastomosis, timing of salvage operation, use of vein graft, and double or single team in the operation. Univariate analysis was performed using Chi- square test and fisher's exact test; whereas multivariate analysis using logistic regression test was undertaken. Results: 59 cases were re-explored due to suspected vascular compromise (re-exploration rate = 22.7%) and 6 flaps failed(success rate = 97.7%). Flap failure was caused by arterial occlusion in 5 cases and venous thrombosis in 1 case. In statistical analysis, flap failure was significantly related to the timing of salvage operation. The other factors did not show any statistical significance. As for the timing of salvage operation, in the successful group, the median time from leaving to returning to theatre was 10.8 hrs. While in the failure group, the median time was 26.7 hrs, which has a significant difference. Conclusion: Any of the head and neck vessels can be chosen as a recipient, as long as it is potent. Post-op close monitoring and prompt salvage operation are crucial in the success of free flaps. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。