目的对上唇癌术后大范围缺损分类，并探讨鼻唇沟瓣联合Abbe瓣或唇红弹性瓣在上唇癌术后大范围缺损中修复效果。
方法纳入2010年1月至2021年12月在中南大学湘雅二医院口腔颌面外科行手术切除的上唇癌患者27例，其中男性13例，女性14例，年龄19~78岁。术后上唇缺损范围均超过50%，采用局部皮瓣（Abbe瓣、鼻唇沟瓣或唇红弹性瓣）修复上唇癌术后缺损。根据缺损的程度和皮瓣的使用类型，将上唇缺损分为3个亚类：①Ⅰ型缺损：上唇正中缺损，唇红缺损超过50%及上唇皮肤近全缺损，可使用Abbe瓣联合双鼻唇沟瓣修复。②Ⅱ型缺损：上唇正中缺损，唇红及上唇皮肤缺损超过50%，单独使用Abbe瓣修复。③Ⅲ型缺损：上唇外侧缺损，唇红及上唇皮肤缺损超过50%，鼻唇沟瓣重建皮肤缺损，唇红弹性瓣修复唇红缺损。使用四分制量表评估患者术后3月唇部的功能和外观，并记录术后并发症。
结果在纳入的唇癌患者中，Ⅰ型、Ⅱ型和Ⅲ型分别为2例、9例和16例。所有的Abbe瓣和鼻唇沟瓣均存活，其中2个Abbe瓣出现尖端坏死并进行修剪。患者术后的平均功能评分为2.89±0.8，平均外观评分为3.04±0.76。
结论基于Abbe瓣联合鼻唇沟瓣的修复方案为上唇癌术后大范围缺损的重建提供了一种新选择。
ObjectiveTo classify the extensive defects after upper lip cancer surgery and explore the efficacy of nasolabial flap with Abbe flap combined or vermilion elastic flap in extensive defects after upper lip cancer ablation.
MethodsTwenty-seven patients with upper lip cancer who underwent surgical resection in the Department of Oral and Maxillofacial, The Second Xiangya Hospital, Central South University from January 2010 to December 2021 were recruited, including 13 males and 14 females aged from 19 to 78 years old. The defects of upper lip were more than 50%, and local flaps (Abbe flap, nasolabial flap or vermilion elastic flap) were used to reconstruct the defects of upper lip cancer. According to the extent of defects and the application type of flaps, the defects were classified into 3 sub-types: ①Type Ⅰ defect: median upper lip defect, with more than 50% defect of vermilion and nearly complete defect of upper lip skin, which can be repaired by Abbe flap combined with double nasolabial flap.②Type Ⅱ defect: median upper lip defect, with more than 50% defect of vermilion and upper lip skin defect, repaired by Abbe flap alone. ③Type Ⅲ defect: lateral upper lip defect, with more than 50% defect of vermilion and upper lip skin defect. The nasolabial flap was used to reconstruct the skin defect, and the vermilion elastic flap was used to repair the labial redness defect. A four-point scale was used to evaluate the function and aesthetic outcome of the lips 3 months after surgery, and postoperative complications were recorded.
ResultsAmong the included patients with lip cancer, there were 2 cases of type Ⅰ, 9 cases of type Ⅱ, and 16 cases of type Ⅲ. All Abbe flap and nasolabial flap survived, with tip necrosis occurring in 2 Abbe flaps and have been resected. The average functional score was 2.89±0.80, and the average cosmetic score was 3.04±0.76.
ConclusionsThe reconstructive method based on Abbe flap and nasolabial flap provides a novel surgical technique for the reconstruction of extensive defects after upper lip cancer surgery.
吴坤,吴汉江. 上唇癌术后大范围缺损分类方式及其修复方案初探[J]. 中华口腔医学杂志,2025,60(03)：262-266.
DOI:10.3760/cma.j.cn112144-20241217-00489版权归中华医学会所有。
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吴坤：论文撰写、收集数据、经费支持；吴汉江：收集数据、修改论文、经费支持
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