喉气管重建术中支架材料的选择及应用效果  

APPLICATION OF VARIOUS MATERIALS IN RECONSTRUCTION OF LARYNGOTRACHEAL FRAMEWORK

作　　者：刘志[1] 崔鹏程[1] 陈文弦[1] 高鹏飞[1] 罗家胜[1] 仲莉梅[1] 

机构地区：[1]第四军医大学唐都医院耳鼻咽喉科,西安710038

出　　处：《中国修复重建外科杂志》2011年第5期551-553,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的观察各种支架材料在喉气管重建术中的治疗效果,分析其优缺点及适应证。方法回顾分析1986年10月-2006年10月采用不同材料行喉气管重建治疗的337例喉气管狭窄患者临床资料。男229例,女108例;年龄2～54岁,中位年龄23.5岁。喉气管支架狭窄程度按照Cotton分度标准:Ⅱ度94例,Ⅲ度218例,Ⅳ度25例。均伴不同程度喉气管支架缺损,缺损长度1～5 cm。采用自体肋软骨移植157例,甲状软骨27例,鼻中隔软骨8例,摇门式胸骨舌骨肌皮瓣104例,胸锁乳突肌舌骨瓣7例,胸锁乳突肌锁骨膜瓣21例,羟基磷灰石人工气管环10例,复合C型镍钛合金网肌皮瓣3例。术后戴硅胶T形管6～12个月。结果术后5例切口感染Ⅱ期愈合,其余患者切口均Ⅰ期愈合;术后戴管期间,因T形管摩擦致气管内肉芽形成23例,因T形管位置过高引起进食呛咳6例,均经对症治疗后治愈。术后失访4例;12例未愈合,其中自体肋软骨移植6例,胸锁乳突肌舌骨瓣1例,摇门式胸骨舌骨肌皮瓣5例;其余321例治愈患者术后均获随访,随访时间1～10年,平均3.5年,患者喉气管均未再次狭窄,吞咽及呼吸功能正常。结论不同喉气管支架材料各有优缺点,根据病变情况选用合适的支架材料重建治疗喉气管狭窄,可获得满意疗效。Objective To investigate the effectiveness of various materials in reconstruction of laryngotracheal framework and to analyze the advantages,disadvantage,and indication of each material.Methods The clinical data were retrospectively analyzed,from 337 laryngotracheal stenosis patients undergoing laryngotracheal framework reconstruction with various materials between October 1986 and October 2006.There were 229 males and 108 females aged from 2 to 54 years（median,23.5 years）.According to Cotton＇s grading criteria for laryngotracheal stenosis,there were 94 cases of grade II,218 cases of grade III,and 25 cases of grade IV,and all accompanied by laryngotracheal framework defect of 1-5 cm.The costal cartilage autograft was performed in 157 cases,thyroid cartilage graft in 27 cases,nasal septal cartilage graft in 8 cases,sternohyoid myocutaneous rotary door flap graft in 104 cases,hyoid bone flap of sternocleidomastoideus graft in 7 cases,musculo-periosteum flap of sternocleidomastoideus with clavicular periosteum in 21 cases,hydroxyapatite artificial tracheal ring graft in 10 cases,and pedicle myocutaneous flap with ＂C＂ shape nickel-titanic alloy net graft in 3 cases.Silastic T-tube was used after reconstruction for 6-12 months.Results Infection occurred in 5 cases and the incisions healed by second intention,the others achieved healing of incision by first intention.Intratracheal granulation formation occurred in 23 cases and choke when taking food in 6 cases;they were all cured after symptomatic treatment.After operation,4 cases failed to be followed up and 12 cases did not recover,including 6 cases of costal cartilage autograft,1 case of hyoid bone flap of sternocleidomastoideus graft,and 5 cases of sternohyoid myocutaneous rotary door flap graft.A total of 321 patients were followed up for 1-10 years（mean,3.5 years）.The patients had no laryngotracheal restenosis with good swallowing function and respiratory function.Conclusion Different materials of laryngotracheal framework reconstruction have advant

关 键 词：喉气管狭窄 喉气管重建 喉气管支架 移植 

分 类 号：R767[医药卫生—耳鼻咽喉科]