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袁宗毅1,赵漾2,周翊飞3,明华伟1,张兴安1,王华东1,李婷1,韩新生1,谭小尧1▲.微血管吻合器结合3D打印数字化手术导板在下颌骨重建中的应用[J].中国医药科学,2021,(4):21-26        基金项目:
微血管吻合器结合3D打印数字化手术导板在下颌骨重建中的应用
Application of microvascular anastomosis combined with 3D printing digital virtual surgical palatein mandibular reconstruction
  
DOI:
中文关键词:  [ 关键词 ] 头颈部肿瘤;腓骨肌皮瓣;血管吻合器;显微外科手术
英文关键词:[Key words] Head and neck tumor; Fibular flap; Vascular anastomosis; Microsurgery
作者单位
袁宗毅1,赵漾2,周翊飞3,明华伟1,张兴安1,王华东1,李婷1,韩新生1,谭小尧1▲ 1. 四川省南充市中心医院 川北医学院第二临床医学院口腔颌面外科,四川南充 637000;2. 川北医学院 附属医院麻醉科,四川南充 637000;3. 四川省阆中市人民医院口腔科,四川阆中 637400 
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中文摘要:
      [ 摘要 ] 目的 探讨微血管吻合器结合 3D 打印数字化手术导板(VSP)在头颈外科颌骨肿瘤切除术后下颌骨重建中的应用体会。 方法 收集 2017 年 8 月至 2019 年 8 月南充市中心医院口腔颌面外科 60 例下颌骨肿瘤患者的相关资料,下颌骨原发灶切除范围均涉及下颌体部及下颌升支,重建均采用腓骨肌瓣。术中使用 3D 打印数字化导板截骨及塑性且使用吻合器吻合血管的患者纳入 VSP+ 吻合器组(n=30);术中行传统手术(常规切除及手工缝合血管)的患者纳入对照组(n=30),术后通过超声多普勒监测皮瓣成活情况。通过比较两组术中原发灶截骨时间、腓骨塑型时间、静脉吻合所需时间、术中静脉吻合后血管漏血情况、术后腓骨瓣存活情况及张口度等指标对两组病例的修复效果进行评价。 结果VSP+ 吻合器组在术中截骨时间与对照组比较,差异无统计学意义(P=0.771),但 VSP+ 吻合器组在腓骨塑形所需时间、静脉吻合时间、术中静脉吻合完毕时吻合口漏血情况及张口度恢复情况方面均优于对照组(P < 0.05),VSP+ 吻合器组在术后远期腓骨瓣存活情况方面与对照组比较,差异无统计学意义(P=0.076),但 VSP+ 吻合器组患者术后腓骨全部存活,而对照组出现 3 例坏死病例。 结论 VSP 结合微血管吻合器在下颌骨肿瘤一期切除重建手术中,提高了手术效率,减少了术后并发症,具有较高临床应用价值。
英文摘要:
      [Abstract] Objective To investigate the application experience of microvascular anastomosis combined with 3D printing digital virtual surgical palate (VSP) in mandibular reconstruction after resection of maxillofacial tumor in head and neck surgery. Methods The relevant data of 60 patients with mandibular tumors admitted to Nanchong Central Hospital oral and maxillofacial surgery from August 2017 to August 2019 were collected. The resection scope of the primary mandibular lesions involved both the mandibular body and the mandibular ramus, and the reconstruction was all performed with fibular flap. Patients who used 3D printing digital VSP for osteotomy and plasticity and anastomosis for blood vessels were included in the VSP combined with anastomosis group (n=30), while those who underwent conventional surgery (conventional resection and manual suture of blood vessels) were included in the control group (n=30).The survival of the flap was monitored by Doppler ultrasound after operation. The indexes of intraoperative primary osteotomy, reconstruction of fibular, time required for venous anastomosis, blood leakage after intraoperative venous anastomosis, postoperative survival of fibular flap and degree of mouth opening between the two groups were compared, and the repair effect of the two groups were evaluated. ResultsThere were no significant differences between the VSP combined with anastomosis group and the control group in the intraoperative osteotomy time (P=0.771).However, in respects of the fibulareconstruction,venous anastomosis time , anastomotic leakage after venous anastomosis during the operation and recovery of degree of mouth opening were superior to those of the control group(P < 0.05). In the long-term survival of the fibular flap after the operation, there was no significant difference between the VSP combined with anastomosis group and the control group (P=0.076). However, all patients in the VSP combined with anastomosis group were survived in the fibula after operation, while there were 3 necrotic cases in the control group, which may be related to the small sample size. Conclusion The 3D printing digital VSP combined with microvascular anastomosis in the stage Ⅰ of resection and reconstruction of mandibular tumor can improve the operation efficiency and reduce incidence of postoperative complications, which has high clinical application value.
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