会厌在外伤性喉气管狭窄整复中的应用

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～2002年2月，收治外伤性喉气管狭窄42例，其中喉狭窄33例，喉气管狭窄9例。年龄9～48岁，平均28．2岁。病程1～26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10～75d拔除气管套管，拔管率为88．1％，5例戴管，占22．9％；42例均于术后9～24d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；25例放置扩张子，拔除时间为9～19d；42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。

APPLICATION OF EPIGLOTTIC IN RECONSTRUCTION OF TRAUMATIC LARYNGOTRACHEAL STENOSIS

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. 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.