术后放射治疗对口腔颌面部组织瓣修复的影响

目的研究术后放射治疗对口腔颌面部组织瓣修复的影响和组织瓣的放射治疗耐受性，为头颈部癌根治术组织缺损立即整复后行术后放射治疗提供临床依据。方法对１１４块口腔颌面部修复组织瓣进行术后放射治疗（４０００～７２００ｃＧｙ，４～７．５周）反应的近期和远期观察，并以放射野内相邻正常口腔粘膜或皮肤为自身对照。结果组织瓣的急性放射反应（包括红肿、糜烂或溃疡）的发生率明显低于相邻的正常组织（Ｐ＜０．０５），且出现晚、程度轻，放射治疗后可完全消退；远期反应也不常见；不同类型修复组织瓣的放射治疗耐受性差异无显著意义；放射治疗后１１４块组织瓣中１１２块（９８．２％）全瓣成活。结论口腔颌面部修复组织瓣有良好的放射治疗耐受性，可安全接受全疗程的常规术后放射剂量照射。

Influence of postoperative radiotherapy on immediate reconstruction flaps in oral and maxillofacial regions

Objective To study the influence of postoperative radiotherapy on immediate reconstruction flaps in the oral and maxillofacial regions and the radiation tolerance of flaps. This study may provide clinical basis of radiotherapy after immediate reconstruction of defects in radical resection for headneck cancers. Methods The radiation response of 114 reconstruction flaps in postoperative radiotherapy (40007200 cGy,47.5wk) was observed. The normal oral mucosa and skin near the flaps served as selfcontrol. Results The rate of acute radiation response in the flaps was obviously lower than normal tissues near the flaps(P <0.05). The response of flaps occurred later and milder and recovered completely after irradiation. The remote radiation response was rare. The radiation tolerance in different kinds of flaps was similar. 112 of 114 reconstruction flaps (98.2%) survived uneventfully after radiotherapy. Conclusions Reconstruction flaps in the oral and maxillofacial regions possessing good radiation tolerance,is able to stand routine postoperative radiation doses.