自体大网膜游离移植在颌面部感染合并复杂窦道治疗中的应用效果

任盼; 曹瑾; 马富鑫; 周帅; 余震; 赵聪颖

doi:10.3760/cma.j.cn501120-20200721-00354

自体大网膜游离移植在颌面部感染合并复杂窦道治疗中的应用效果

doi: 10.3760/cma.j.cn501120-20200721-00354

1.
空军军医大学第二附属医院整形烧伤科，西安　　710038
2.
空军军医大学第二附属医院普通外科，西安　　710038

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通讯作者:
赵聪颖，Email：xiaoyanmale20@126.com

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出版历程
- 收稿日期: 2020-07-21

Application effects of free transplantation of autologous omentum in treating maxillofacial infection complicated with complex sinus tract

1.
Department of Burns and Plastic Surgery, the Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, China
2.
Department of General Surgery, the Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, China

More Information

Corresponding author: Zhao Congying, Email: xiaoyanmale20@126.com

摘要

摘要: 目的探讨自体大网膜游离移植治疗颌面部感染合并复杂窦道的效果。方法采用回顾性观察性研究方法。2017年7月—2019年12月空军军医大学第二附属医院整形烧伤科收治颌面部感染合并复杂窦道患者4例，其中男3例、女1例，年龄36~60岁。患者术前行面部CT检查，计算窦道体积；术中对窦道进行充分清创，清创后组织缺损体积为5 cm×3 cm×2 cm~10 cm×5 cm×3 cm。腹腔镜下切取100~300 mL大网膜填充组织缺损区域，保留大网膜右侧动静脉作为供区血管蒂，分别与受区面动脉及颈外静脉进行吻合。术后观察大网膜成活情况、受区再次感染和并发症发生情况。术后第10天、1个月，彩色多普勒超声及CT血管造影检查移植大网膜血运情况，头面部CT检查组织缺损区域填充情况。术后随访，观察面部外观和功能恢复情况及供区瘢痕增生情况。结果 4例患者移植大网膜术后均成活，无再次感染及并发症发生。术后第10天、1个月，移植大网膜血运良好，大网膜填充区域形态良好，未见无效腔形成。术后随访6~10个月，面部外观及功能恢复良好，供区无明显瘢痕增生。结论大网膜游离移植治疗颌面部感染合并复杂窦道后，患者面部外观及功能良好，腹腔镜的应用对患者损伤小，术后恢复快。
- 外科手术 /
- 感染 /
- 复杂窦道 /
- 颌面部 /
- 大网膜游离移植
Abstract: Objective To investigate the application effects of free transplantation of autologous omentum in treating maxillofacial infection complicated with complex sinus tract. Methods The retrospective observational study method was used. Four patients with maxillofacial infection complicated with complex sinus tract were admitted to Department of Burns and Plastic Surgery of the Second Affiliated Hospital of Air Force Medical University from July 2017 to the December 2019, including 3 males and 1 female aged 36-60 years. Preoperative facial computed tomography (CT) was performed on patients for calculating the volume of sinus tract. During the operation, the sinus tract was thoroughly debrided, and the volume of the tissue defect was about 5 cm×3 cm×2 cm-10 cm×5 cm×3 cm after debridement. The tissue defect area was filled with omentum of 100-300 mL which was cut under laparoscopy. The artery and vein on the right side of the omentum were reserved as the vascular pedicle of the donor area, which were anastomosed with the facial artery and external jugular vein of the recipient area. The survival of omentum, and the occurrences of reinfection and complication were observed after operation, respectively. On the 10th day and in 1 month after the operation, the blood supply of omentum was examined by colored Doppler ultrasound and CT angiography, and the filling of tissue defect area was examined by head and face CT. During follow-up after the operation, the recoveries of face appearance and function and scar hyperplasia in the donor area. Results The transplanted omentums in 4 patients survived after the operation with no reinfection and complication. On the 10th day and in 1 month after the operation, the transplanted omentums had good blood supply, and the filled area with omentum was in good shape, without formation of dead cavity. During follow-up of 6-10 months after surgery, the appearance and function of face recovered well, and there was no obvious scar hyperplasia in the donor area. Conclusions After free transplantation of omentum in treating maxillofacial infection with complex sinus tract, the patients have good facial appearance and function, and the application of laparoscopy results in little damage to the patients and quick postoperative recovery.
- Surgical procedures, operative /
- Infection /
- Complie sinus tract /
- Maxillofacial region /
- Free transplantation of omentum
所有作者均声明不存在利益冲突

肠道屏障的完整性对维持肠道稳态至关重要，而烧伤导致肠道屏障失调的具体机制尚不完全明确。陆军军医大学(第三军医大学)第一附属医院全军烧伤研究所Fengjun Wang教授团队近期在《Burns & Trauma》发文《Severe burn injury alters intestinal microbiota composition and impairs intestinal barrier in mice》，该文主要研究小鼠烧伤后肠道菌群及肠道屏障功能的改变，并进一步阐述烧伤导致肠道屏障失调的机制。取30%TBSAⅢ度烧伤小鼠为实验组，测定其肠道通透性、紧密连接蛋白表达、带状闭合蛋白1(ZO-1)定位、炎性细胞因子表达和短链脂肪酸（SCFA）的含量，通过16S 核糖体DNA基因测序检测肠道菌群。结果表明严重烧伤后小鼠的肠道通透性显著增加，在烧伤后6 h达到高峰，是正常对照组的20倍；紧密连接蛋白、闭锁蛋白、闭合蛋白-1、闭合蛋白-2均显著改变，ZO-1的形态在烧伤后发生了明显的变化；SCFA在烧伤后显著减少；烧伤后回肠黏膜促炎性细胞因子,如IL-1β、IL-6等表达升高，而抗炎细胞因子，如IL-4、IL-13等表达降低。此外，烧伤小鼠的肠道菌群组成也会发生改变，例如菌群多样性降低、拟杆菌丰度降低和厚壁菌丰度升高。该文结论为严重烧伤导致肠道屏障破坏可能与菌群结构变化相关。

刘洋，编译自《Burns Trauma》，2019, 7:20；郇京宁，审校

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参考文献(35)

[1]	KameiY,NakayamaB,ToriyamaK,et al.Combined fibular osteocutaneous and omental flaps[J].Plast Reconstr Surg,2007,119(5):1499-1504.DOI: 10.1097/01.prs.0000256065.62382.89.
[2]	PatelRS,GilbertRW.Utility of the gastro-omental free flap in head and neck reconstruction[J].Curr Opin Otolaryngol Head Neck Surg,2009,17(4):258-262.DOI: 10.1097/MOO.0b013e32832cba42.
[3]	李威,杨旭东,王志勇,等.数字化技术辅助颌骨截骨及颌面修复的临床应用[J].口腔颌面外科杂志,2018,28(2):75-79.DOI: 10.3969/j.issn.1005-4979.2018.02.004.
[4]	吕春堂,张庆福.精准颌骨外科应用与展望[J].口腔颌面外科杂志,2018,28(4):181-186.DOI: 10.3969/j.issn.1005-4979.2018.04.001.
[5]	李博生, 罗伟良, 刘武, 等. 血管内支架置入术治疗鼻咽癌放疗所致颈动脉血管损伤后血管狭窄率的研究[J]. 黑龙江医学, 2016,40(9):841-842.DOI: 10.3969/j.issn.1004-5775.2016.09.027.
[6]	唐茂玲超声探讨腹部脏器放疗对周围大动脉早期损伤的实验研究南充川北医学院2020DOI: 10.27755/d.cnki.gcbyx.2020.000193 唐茂玲. 超声探讨腹部脏器放疗对周围大动脉早期损伤的实验研究[D]. 南充:川北医学院, 2020. DOI: 10.27755/d.cnki.gcbyx.2020.000193.
[7]	范稀文, 王高仁, 赵森. 放疗致颈动脉损伤的研究进展[J]. 肿瘤学杂志, 2017,23(3):221-226. DOI: 10.11735/j.issn.1671-170X.2017.03.B013.
[8]	邢培朋, 郭海娜, 狄海萍, 等. 游离股前外侧皮瓣联合动脉血管重建修复腕部高压电烧伤创面的临床效果[J]. 中华烧伤杂志, 2020,36(6):419-425. DOI: 10.3760/cma.j.cn501120-20200219-00067.
[9]	李俊,杨定文.自体大网膜游离移植在修复皮肤软组织缺损中的应用[J].江苏医药,2002,28(7):523-524.DOI: 10.3969/j.issn.0253-3685.2002.07.020.
[10]	TaoSX,TianGQ,GeMH,et al.Primary extraskeletal osteosarcoma of omentum majus[J].World J Surg Oncol,2011,9:25.DOI: 10.1186/1477-7819-9-25.
[11]	李俊,杨定文,袁光海.四肢大面积皮肤缺损的显微外科治疗[J].中国厂矿医学,2002,15(6):455-456.DOI: 10.3969/j.issn.1674-8182.2002.06.010.
[12]	王刚成,韩广森,冯小杰,等.改良带蒂大网膜修复膀胱阴道残端瘘技术的临床效果[J].中华外科杂志,2013,51(5):469-470.DOI: 10.3760/cma.j.issn.0529-5815.2013.05.024.
[13]	谢宏彬,夏兆骥,杨欣.一例大网膜游离移植矫正半侧颜面萎缩病例的25年随访[J].中国美容医学,2008,17(12):1741-1742.DOI: 10.3969/j.issn.1008-6455.2008.12.010.
[14]	McLeanDH,BunckeHJ.Autotransplant of omentum to a large scalp defect, with microsurgical revascularization[J].Plast Reconstr Surg,1972,49(3):268-274. DOI: 10.1097/00006534-197203000-00005.
[15]	HariiK,OmoriS.Use of the gastroepiploic vessels as recipient or donor vessels in the free transfer of composite flaps by microvascular anastomoses[J].Plast Reconstr Surg,1973,52(5):541-548.DOI: 10.1097/00006534-197311000-00012.
[16]	江华,仇明,赵耀忠,等. 腹腔镜技术应用于吻合血管大网膜游离移植治疗半侧颜面萎缩[J]. 第二军医大学学报, 2005,26(1):41-43. DOI: 10.3321/j.issn:0258-879X.2005.01.014.
[17]	李南林, 郑朝, 李纪鹏, 等. 游离大网膜移植即刻再造乳房7例[J/CD]. 中华乳腺病杂志:电子版, 2016,10(4):210-214. DOI: 10.3877/cma.j.issn.1674-0807.2016.04.004.
[18]	计鹏,韩军涛,谢松涛,等.腹腔镜下切取大网膜游离移植修复肢体复杂创面[J].山西医科大学学报,2016,47(6):570-573.DOI: 10.13753/j.issn.1007-6611.2016.06.020.
[19]	张旭东. 腹腔镜辅助下大网膜移植加负压封闭引流术在难愈性创面中的应用[J]. 创伤外科杂志, 2014,16(3):269.
[20]	徐秋,张治星,苏阳.乳腺癌腔镜保乳肿瘤整形手术中利用腔镜带蒂大网膜获取技术的临床应用效果[J].中国医疗美容,2020,10(1):19-23.DOI: 10.19593/j.issn.2095-0721.2020.01.006.
[21]	李海峰.游离股前外侧皮瓣用于口腔肿瘤术后组织缺损修复的效果观察[J].感染、炎症、修复,2018,19(1):3.DOI: 10.3969/j.issn.1672-8521.2018.01.012.
[22]	张磊, 李欣, 秦兴军, 等. 修复口腔癌术后缺损的股前外侧皮瓣供区积液的临床分析[J]. 中国癌症杂志, 2020,30(12):1026-1030. DOI: 10.19401/j.cnki.1007-3639.2020.12.010.
[23]	宋达疆, 李赞, 章一新, 等. 股前内侧穿支皮瓣修复口腔癌缺损的效果[J]. 中华医学美学美容杂志, 2020,26(5):398-401. DOI: 10.3760/cma.j.issn.1671-0290.2020.05.012.
[24]	宋向阳. 腹腔镜技术获取大网膜在乳腺癌术后乳房重建中应用[J]. 中国实用外科杂志, 2020,40(10):1146-1149. DOI: 10.19538/j.cjps.issn1005-2208.2020.10.09.
[25]	王子函, 张玉龙, 屈翔. 利用大网膜组织行乳房重建技术[J]. 中国实用外科杂志, 2019,39(11):1235-1237. DOI: 10.19538/j.cjps.issn1005-2208.2019.11.27.
[26]	王子函, 辛培, 张忠涛, 等. 腹腔镜下获取带蒂大网膜瓣在乳腺癌术后乳房重建中的应用价值[J/CD]. 中华乳腺病杂志:电子版, 2019,13(2):65-68. DOI: 10.3877/cma.j.issn.1674-0807.2019.02.001.
[27]	李学雷, 江奕恒, 钟世镇. 大网膜移植的应用解剖[J].中华显微外科杂志, 2011,34(4):305-308. DOI: 10.3760/cma.j.issn.1001-2036.2011.04.014.
[28]	吕振晔,管丹丹,宋向阳,等.应用大网膜行乳腺肿瘤整形的现状分析[J].中华整形外科杂志,2019,35(6):622-624.DOI: 10.3760/cma.j.issn.1009-4598.2019.06.020.
[29]	BohnerL,GambaDD,HanischM,et al.Accuracy of digital technologies for the scanning of facial, skeletal, and intraoral tissues: a systematic review[J].J Prosthet Dent,2019,121(2):246-251.DOI: 10.1016/j.prosdent.2018.01.015.
[30]	DuY,LuBY,ChenJ,et al.Measurement of the orbital soft tissue volume in Chinese adults based on three-dimensional CT reconstruction[J].J Ophthalmol,2019,2019:9721085.DOI: 10.1155/2019/9721085.
[31]	WuPS,MatooR,SunH,et al.Single-stage soft tissue reconstruction and orbital fracture repair for complex facial injuries[J].J Plast Reconstr Aesthet Surg,2017,70(2):e1-e6.DOI: 10.1016/j.bjps.2016.10.021.
[32]	潘希贵,田万成,管同勋,等.以指动脉为蒂第一掌背动脉逆行岛状皮瓣修复示指皮肤缺损[J].中华显微外科杂志,2005,28(1):92.DOI: 10.3760/cma.j.issn.1001-2036.2005.01.054.
[33]	McIntyreBC,LobbD,NavarroF,et al.Laparoscopic free omental flap for craniofacial reconstruction: a video article demonstrating operative technique and surgical applications[J].J Craniofac Surg,2017,28(2):311-313.DOI: 10.1097/SCS.0000000000003343.
[34]	ZahaH,InamineS,NaitoT,et al.Laparoscopically harvested omental flap for immediate breast reconstruction[J].Am J Surg,2006,192(4):556-558.DOI: 10.1016/j.amjsurg.2006.06.030.
[35]	李国鹏, 万能斌, 邓宏武, 等. 腹腔镜下游离带蒂大网膜在保乳术乳房成形中的应用[J]. 中国现代手术学杂志, 2016,20(3):164-166. DOI: 10.16260/j.cnki.1009-2188.2016.03.002.

1 大网膜游离移植修复脑膜瘤患者术后颌面部感染合并复杂窦道。1A.入院时左眼可见脓性分泌物，眶区以及左侧颜面部皮肤发红，软组织萎缩塌陷；1B.术中手术切口设计；1C.术中沿设计切口切开后可见感染已侵犯上颌骨，可见骨质呈灰白色，为骨坏死表现；1D.术中切除部分上颌骨以及全部坏死的软组织后；1E.术中切取的大网膜组织；1F.术后第1天，左侧面部肿胀明显；1G.术后第10天，头面部CT三维重建以及CT血管造影显示上颌骨切除范围及头面部血管情况；1H.术后半年，面型恢复良好，未见再次感染

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