会厌在外伤性喉气管狭窄整复中的应用  

APPLICATION OF EPIGLOTTIC IN RECONSTRUCTION OF TRAUMATIC LARYNGOTRACHEAL STENOSIS

作　　者：王惠忠[1] 栾信庸[1] 李勇[1] 

机构地区：[1]山东大学齐鲁医院耳鼻咽喉科

出　　处：《中国修复重建外科杂志》2005年第2期138-140,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的　探讨会厌在外伤性喉气管狭窄整复中的应用及术后疗效。　方法　 1988年 1月～ 2 0 0 2年2月 ,收治外伤性喉气管狭窄 4 2例 ,其中喉狭窄 33例 ,喉气管狭窄 9例。年龄 9～ 4 8岁 ,平均 2 8.2岁。病程 1～ 2 6个月 ,平均 10 .2个月。均采用手术治疗 ,方法 :1会厌下移 +胸骨舌骨肌肌筋膜瓣整复术 ;2会厌下移 +胸骨舌骨肌肌筋膜瓣 +胸锁乳突肌锁骨膜瓣整复术。　结果　术后 37例 10～ 75 d拔除气管套管 ,拔管率为 88.1% ,5例戴管 ,占 11.9% ;4 2例均于术后 9～ 2 4 d拔除胃管 ,其中 5例轻度误吸 ,经练习后 1周内均恢复正常进食 ;2 5例放置扩张子 ,拔除时间为9～ 19d;4 2例中 5例术后 2～ 5个月有肉芽组织生长 ,经支撑喉镜下激光治疗 1～ 3次治愈 ;术后均获 1年～ 3年 4个月随访 ,37例拔管者喉功能完全恢复 ,5例戴管者部分恢复喉功能。　结论　会厌用于整复喉气管狭窄 ,具有取材简便、抗感染能力强、成活率高及结构稳定等优点 ,与双肌蒂胸骨舌骨肌肌筋膜瓣联合应用能修复较大范围的缺损。胸锁乳突肌锁骨膜瓣其骨膜面光滑而致密 ,不易发生萎缩 ,是修复气管壁缺损的理想材料。Objective To investigate the application and long term results of epiglottic in reconstruction of the traumatic laryngotracheal stenosis.Methods From January 1988 to February 2002, 42 patients with traumatic laryngotracheal stenosis were treated, including 33 laryngeal stenosis and 9 laryngotracheal stenosis. The following surgical treatment were performed: ① lowered epiglottic and bi pedicled sternohyoid myofascial flap and ② lowered epiglottic and bi pedicled sternohyoid myofascial flap and sternocleidomastoideus clavicle membrane flap. Results Thirty seven patients(88.1%) were successfully decannulated 10 to 75 days after operation. Feeding tube lasted from 9 to 24 days, all the patients rehabilitated deglutition after surgery. The time of using stent was 9 to 19 days in 25 cases.All patients were followed up 1 year to 3 years and 4 months. The function of larynx recovered completely in 37 decannulated patients and partially in 5 cannulated patients. a(c)Conclusion Epiglottic has the advantages of easy gain, high anti infection and survival rate, and stable structure. A combination of epiglottic and the bi pedicled sternohyoid myofascial flap plus sternocleidomastoideus clavicle membrane flap can repair large laryngeal and tracheal defects. ?3/4

关 键 词：喉气管狭窄 会厌 术后 整复 外伤性 舌骨 肌筋膜 抗感染能力 恢复 生长 

分 类 号：R767[医药卫生—耳鼻咽喉科] R739[医药卫生—临床医学]