颈阔肌皮瓣修复颈部食管狭窄的研究  

Reconstruction of cervical esophageal stenosis with platysma myocutaneous flap

作　　者：王如文[1] 蒋耀光[1] 龚太乾[1] 周景海[1] 赵云平[1] 马铮[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所全军胸外科中心,重庆400042

出　　处：《第三军医大学学报》2007年第9期749-751,共3页Journal of Third Military Medical University

摘　　要：目的总结颈阔肌皮瓣修复颈部食管狭窄经验。方法29例颈部食管长2.0～4.5cm的狭窄患者,其中结肠代食管术后颈部吻合口狭窄21例(17例由他院术后转入),胃代食管术后颈部吻合口狭窄2例,食管烧伤后局限性颈段食管狭窄3例,医源性损伤狭窄2例,颈段食管利刃横断伤后食管闭锁1例。纵行切开狭窄,上、下各超过1cm,切取(4～5)cm×(6～7)cm大小的颈阔肌皮瓣内翻缝合于狭窄切开边缘。结果肌皮瓣全部成活,无术后死亡,发生瘘3例,更换敷料愈合。全组随访6～192个月,平均78个月,2例发生狭窄,1例行食管扩张,另1例食管成形治愈;均能正常经口进食。结论术中注意颈阔肌皮瓣解剖及切取,保证肌皮瓣的血供是手术成功的关键。Objective To summarize the experience on reconstruction of cervical esophageal stenosis with platysma myocutaneous flap. Methods Twenty-nine cases suffered from cervical esophageal stenosis which affected 2.0 -4.5 cm in length, including 21 cases of cervical stoma stenosis after esophagus replacement with colon （17 cases transferred from other hospitals）, 2 cases of cervical stoma stenosis after esophagus replacement with stomach, 3 cases of local cervical stoma stenosis after esophageal bums, 2 cases of iatrogenic stenosis, 1 case of esophagus blocking after sharp blade transsection on cervical esophagus. The stenosis was cut open to 1 cm beyond its upper and lower edges. The platysma flaps about （4 - 5 ） cm × （6 - 7 ） cm in size were sutured by introversion with the edges of stenosis. Results All the flaps survived and no death occurred due to operation process. Three fistulae occurred and were healed after dressing changes. The follow-up lasting 6 to 192 months （average 78 months） was performed. Two cases of stenosis occurred, 1 case was given esophageal dilatation and another received esophagoplasty. All the patients could take food by mouth. Conclusion The key of operation is to guarantee good blood supply of platysma flap in anatomy and dissection.

关 键 词：颈阔肌皮瓣 食管狭窄 食管修复 

分 类 号：R571.1[医药卫生—消化系统] R622.1[医药卫生—内科学]