异种脱细胞真皮基质、异体脱细胞真皮基质与自体皮瓣修复颌面部软组织缺损疗效对比

胡琼方 胡永琼 梅时友

[摘要]目的：对比异种脱细胞真皮基质、异体脱细胞真皮基质与自体皮瓣修复颌面部软组织缺损的临床效果。方法：收集76例颌面部软组织缺损患者的临床资料，26例进行异种脱细胞真皮基质修复术（异种组），25例进行异体脱细胞真皮基质修复术（异体组），25例进行自体皮瓣修复术（自体组）。对比三组患者住院时间、术后疼痛程度、移植物成活率及术后并发症。结果：异种组和异体组住院时间均短于自体组（P<0.05），且异种组和异体组相比无统计学差异（P>0.05）;异种组和异体组VAS疼痛评分均低于自体组（P<0.05），且异种组和异体组相比无统计学差异（P>0.05）;三组患者移植物成活率相比，差异无统计学意义（P>0.05），异种组并发症发生率低于自体组（P<0.01）。结论：在颌面部软组织缺损修复中，异种脱细胞真皮基质、异体脱细胞真皮基质具有与自体皮瓣相当的移植物成活率，且异种ADM和异体ADM能够减轻患者术后疼痛程度，减少并发症发生，缩短住院时间，安全可靠。

[关键词]脱细胞真皮基质;自体皮瓣;口腔颌面部;软组织缺损;修复

[中图分类号]R782.2    [文献标志码]A    [文章编号]108-6455（2020）07-0061-03

Abstract： Objective  To compare the clinical effect of xenogeneic acellular dermal matrix，allogeneic acellular dermal matrix and autologous skin flap in the repair of soft tissue defects of oral and maxillofacial. Methods  The clinical data of 76 patients with soft tissue defects of oral and maxillofacial were collected， among which 26 cases treated with xenogeneic acellular dermal matrix repair were recorded as xenogeneic group， 25 cases treated with allogeneic acellular dermal matrix repair were recorded as allogeneic group， and 25 cases were treated with autogenous skin flap repair were recorded as autogenous group. The length of stay， postoperative pain， graft survival rate and postoperative complications were compared among the three groups. Results  The hospitalization time of the xenogeneic group and the allogeneic group was shorter than that of the autogeneic group （P<0.05）， and there were no significant difference between the xenogeneic group and the allogeneic group （P>0.05）. The VAS pain scores of the xenogeneic group and the allogeneic group were lower than that of the autogenous group （P<0.05）， and there were no significant difference between the xenogeneic group and the allogeneic group （P>0.05）. There were no significant difference in the survival rate of the three groups （P>0.05）. The incidence of complications in the heterologous group was lower than that in the autogenous group （P<0.01）.  Conclusion  In the repair of soft tissue defects of oral and maxillofacial， xenogeneic ADM and allogeneic ADM have graft survival rates comparable to autologous skin flaps， and heterogeneous ADM and allogeneic ADM can reduce postoperative pain， reduce complications， shorten hospital stays， safe and reliable.

Key words： acellular dermal matrix; autologous skin flap; oral and maxillofacial; soft tissue defects; repair

頜面部受到刺伤、挫伤、撕裂伤等面部外伤或颌面部肿瘤切除等都会造成颌面部软组织缺损，造成患者面部表情、咀嚼吞咽及语言表达等功能障碍，严重影响患者生理、心理健康和参与社会的能力[1-2]。目前临床以手术修复为主要手段，包括异种脱细胞真皮基质（acellular dermal matrix，ADM）、异体ADM和自体皮瓣作为缺损修复材料，且既往研究表明这三种修复手段对颌面部软组织缺损的修复均具有确切效果[3-4]。然而三种修复方法在颌面部软组织缺损的具体临床疗效对比，临床尚无系统性的研究。因此，本研究特回顾性分析笔者医院行异种脱细胞真皮基质、异体脱细胞真皮基质和自体皮瓣修复术的颌面部软组织缺损患者的临床资料，探讨对比三种修复术对颌面部缺损患者的修复效果，现报道如下。