局部组织瓣在喉切除术后一期重建中的应用

目的 探讨局部组织瓣在喉切除术后一期重建中的应用方法及效果。 方法 2002年至2011年山东大学齐鲁医院耳鼻咽喉科对因喉恶性肿瘤住院的患者行手术治疗,并应用胸骨舌骨肌瓣、接力肌瓣、会厌瓣、颈前皮瓣、胸大肌肌皮瓣于喉切除后一期重建喉腔及喉功能。 结果 随访喉癌患者共计658例,均行气管切开术,一期手术均成功保留喉功能。应用胸骨舌骨肌瓣546例、接力肌瓣45例、会厌瓣39例、颈前皮瓣28例、胸大肌肌皮瓣1例。 结论 局部组织瓣具备取材丰富、制备简单、方式多样、血运良好的特点,可极大程度满足大多数喉腔术后一期重建的要求,在喉恶性肿瘤的喉功能保留手术中有着不可替代的作用。

The application of local tissue flaps in primary reconstruction of laryngeal function after laryngectomy

Objective To discuss and evaluate the application and outcomes of local tissue flaps in primary reconstruction of laryngeal function after laryngectomy. Methods A retrospective analysis of 658 operations in patients with laryngeal carcinoma from the Department of Otolaryngology, Qilu Hospital of Shandong University, was performed. The patients underwent primary reconstruction of laryngeal function immediately following laryngectomy using the sternohyoid flap, thyrohyoid flap, epiglottis flap, pre-cervical skin flap, and/or pectoralis major flap. Results All patients received a tracheotomy and had their laryngeal function preserved in the primary surgery. Five hundred and forty-six patients underwent single or combination sternohyoid flap reconstruction. Forty-five patients underwent single or combination thyrohyoid flap reconstruction. Thirty-nine patients underwent reconstruction with the epiglottis flap. Twenty-eight patients underwent reconstruction with the pre-cervical skin flap. The total 3-year survival rate was 83.01%, and the total 5-year survival rate was 72.53%. The total extubation rate was 86.04%. Conclusion The use of local tissue flaps is advantageous for reconstruction in head and neck surgery because of their good blood supply, their ability to support a variety of surgical options, and the surgical simplicity of the operations in which they are used. Local flaps play an important role in one-stage reconstruction of laryngeal function when used flexibly.