國際癌症研究總署（IARC）2003年研究報告顯示：2000年口腔癌在全球常見癌症發生率排行榜中名列第11。根據2006年衛生署統計，口腔癌位居男性癌症死因的第四位。自由皮瓣（Free Flap）移植的出現改革了整型手術的醫療方式，使得先前不可能之複雜的重建手術得以完成。目前對於口腔癌之治療方式是將腫瘤切除後，再利用自由皮瓣將其頭頸部重建。然而遇到血管損傷而迫使手術翻修的自由皮瓣其比例約佔10％。由於皮瓣組織的缺血耐受在幾小時內將達上限，因而可能形成不能倒逆的瀰散性血栓症（Irreversible Disseminated Thrombi）。所以，立即的血流灌注缺乏偵測與迅速的翻修對於皮瓣的搶救是至關緊要的。因此，需要在術後對於皮瓣血液灌注周密的監測以早期診斷出皮瓣血流灌注缺乏。

本研究目的為設計發展自由皮瓣術後溫度監測系統應用於頭頸部重建。其特定目標：（1）設計溫度監測系統雛型，來監測皮瓣的存活情形;（2）藉由臨床試驗，測試與評估皮瓣溫度監測系統的可行性。本研究首先考量自由皮瓣溫度監測系統臨床的需求與功能性設計，此溫度監測系統設計雛型主要包括：溫度感測探頭、單晶片微處理器、七段顯示與溫度指標燈號（紅、綠、藍）、串列傳輸、電源等，然後以高階多功能生理監視器電子溫度計模組與本研究溫度監測系統雛型作校正。再來透過臨床的實驗設計探討此溫度監測系統量測自由皮瓣的血流灌注情形以驗證臨床應用的可行性，記錄與分析皮瓣溫度監測結果。

本研究目前已完成：（1）溫度監測系統雛型，（2）臨床皮膚溫度監測實驗評估此溫度監測系統的可行性。經由實驗結果顯示，溫度監測系統雛型能持續監測溫度的變化48小時以上，達到長時間監測的目的。另外皮瓣溫度數值與皮瓣狀態結合為簡單的指標，提供醫療人員簡易的使用。

未來可繼續探討其缺失並發展改良，包括以下幾點：（1）能進行多名自由皮瓣頭頸部重建患者皮瓣溫度監測實驗，以期能提供自由皮瓣在術後血管吻合與血流灌注情形一個完整的臨床參考依據，達到立即的血流灌注缺乏偵測的目的；（2）建立友善的溫度監測系統的使用者操作介面與定時自動存檔功能，增加醫療人員系統操作的便利性；（3）建立警示功能，當系統判斷皮瓣有問題時，能透過通訊網路即時回報醫療人員。

In 2003, the International Agency for Research on Cancer has reported that the oral cancer is ranked No.11 among the incidence of all cancers in 2000. The report from the Department of Health, Executive Yuan in 2006 has showed that the mortality of oral cancer is the fourth leading cause of cancer-related death. The advent of tissue transfer revolutionized the armamentarium of the plastic surgeon and allowed the performing of complex reconstructions that were previously not possible. At present, head and neck free reconstruct surgery is the main method to treat patients who need to perform resection of oral cancer and reconstruct tissue defect. Vascular compromise necessitating surgical revision is encountered in about 10% of free flaps. Since ischemic tolerance of the flap tissue is limited to a few hours and irreversible disseminated thrombi may form immediate detection of perfusion failure and prompt revision is crucial for flap salvage. Thus, close monitoring of flap perfusion is mandatory in the postoperation for early diagnosis.

The purpose was to design and develop a temperature monitoring system for free flaps on head and neck reconstruction. More specifically, this research was aimed to:（1）design a prototype of temperature monitoring system to monitor the flap survival, and（2）evaluate the clinical efficacy of the temperature monitoring system. First, conceptual design and functional requirements were considered. The prototype design consists of a temperature sensing probe, microprocessors, Seven-Segment display and temperature indicator lights (red, green, blue), serial transmission of PC, power supply. The system is calibrated through a multi-functional physiological monitor electronic thermometer. The feasibility of clinical application is experimented by using able-body subjects and subjects with free flaps on head & neck reconstruction.

This research has completed the temperature monitoring prototype. The experimental results from the able-bodied subject show that the prototype of the temperature monitoring system can monitor the temperature change continually more than 48 hours and achieve the purpose of monitoring long period of time. The flap temperature distribution combing with clinical indicators of state of flap provide medical personnel easy to use.

Further research is recommended to include:（1）conduct clinical trial to verify the efficiency of monitoring flap temperature to achieve early detection of perfusion failure; （2）establish a friendly GUI with data log function to facilitate medical usage; and（3）establish an alarm function to the medical personnel immediately though the network while the system detect flap problem happened.

[1] 行政院衛生署國民健康局
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