前臂桡侧皮瓣与股前外侧皮瓣修复软腭癌术后缺损的临床疗效及预后对比

Comparisons of clinical efficacy and prognosis between radial forearm flap and anterolateral thigh flap in repairing defects after soft palate cancer surgery

摘要:

目的 分析前臂桡侧皮瓣（RFF）与股前外侧皮瓣（ALT）用于软腭癌术后缺损重建的临床疗效，对比两种皮瓣在手术修复结局、术后功能转归及肿瘤远期预后方面的差异，为临床软腭癌术后缺损个体化修复方案的制订提供参考。方法 本研究采用回顾性分析方法，收集2017年11月—2025年6月于福建医科大学附属第二医院接受治疗的25例软腭癌患者的临床资料，其中13例患者接受RFF修复（RFF组），12例患者接受ALT修复（ALT组）。比较两组皮瓣的术中相关参数，包括皮瓣面积、血管蒂长度、皮瓣制备时间；观察患者术后并发症（皮瓣坏死、咽瘘、出血等）的发生情况；评估患者术后吞咽、言语及鼻咽反流功能恢复情况；对比两组患者的肿瘤复发率与总体生存率差异。结果 两组皮瓣成活率均处于较高水平，差异无统计学意义（P=0.740）。RFF组皮瓣面积显著小于ALT组，差异具有统计学意义（P=0.003），且皮瓣制备时间长于ALT组，差异具有统计学意义（P= 0.042）。RFF组与ALT组术后分别发生3例、2例并发症，组间差异无统计学意义(P=0.541)。功能评估结果显示，两组患者术后言语、吞咽及鼻咽反流均恢复良好，各项功能指标的组间差异均无统计学意义（均P＞0.05）；但相较于ALT组，RFF组患者的言语功能与吞咽功能恢复更具优势，而RFF组鼻咽反流的发生风险较ALT组呈更高趋势。两组患者术后并发症发生率、累积生存率差异均无统计学意义（P均＞0.05），ALT组的肿瘤复发率与远处转移风险呈更高趋势。结论 RFF与ALT均可有效重建软腭癌术后缺损，能够良好地恢复患者术后吞咽及言语功能，二者临床疗效与肿瘤远期预后均整体可靠。临床工作中可根据软腭缺损范围、手术时长要求及患者个体基础条件，选择个体化的皮瓣修复方案。

Abstract:

Objective To analyze the clinical efficacy of the radial forearm flap (RFF) and the anterolateral thigh flap (ALT) in reconstructing postoperative defects of the soft palate cancer, and to compare the differences in surgical repair outcomes, postoperative functional recovery, and long-term prognosis between the two flaps, so as to provide a reference for the formulation of individualized repair plans for postoperative defects of soft palate cancer in clinical practice. Methods This study adopted a retrospective analysis method. The clinical data of 25 patients with soft palate cancer who were treated at the Second Affiliated Hospital of Fujian Medical University from November 2017 to June 2025 were collected. Among them, 13 patients received repair with the RFF (RFF group), and 12 patients received repair with the ALT (ALT group). The intraoperative relevant parameters of the two flaps were compared, including flap area, vascular pedicle length, and flap preparation time. The occurrence of postoperative complications (such as flap necrosis, pharyngeal fistula, bleeding, etc.) was observed. The recovery of postoperative swallowing, speech, and nasopharyngeal reflux was evaluated, and the differences in tumor recurrence rate and overall survival rate between the two groups were compared. Results The survival rates of the two groups were both relatively high, and the difference was statistically insignificant (P=0.740). The flap area of the RFF group was significantly smaller than that of the ALT group, and the difference was statistically significant (P=0.003). The preparation time of the RFF group was longer than that of the ALT group, and the difference was statistically significant (P=0.042). There were 3 cases of complications in the RFF group and 2 in the ALT group after surgery, and the difference between the two groups was statistically insignificant (P=0.541). The functional assessment results showed that the postoperative speech, swallowing functions, and nasopharyngeal reflux of the two groups recovered well, and there were no statistically significant differences in various functional indicators (all P>0.05). However, compared with the ALT group, the speech and swallowing functions of patients in the RFF group recovered more advantageously, and the risk of nasopharyngeal reflux in the RFF group was higher than that in the ALT group. There were no statistically significant differences in the incidence of postoperative complications and overall survival rate between the two groups (all P>0.05), and the tumor recurrence rate and distant metastasis risk of the ALT group were higher. Conclusions Both the RFF and ALT flaps can effectively reconstruct postoperative defects of soft palate cancer and can well restore the postoperative swallowing and speech functions of patients. The clinical efficacy and long-term prognosis of both are overall reliable. In clinical practice, individualized flap repair plans can be selected based on the size of the soft palate defect, the duration of the surgery, and the individual basic conditions of the patients.