带蒂皮瓣肌膜瓣修复喉次全切除组织缺损与喉功能重建

目的：探讨喉次全切除术后创面修复及喉功能的重建。方法：对33例喉癌患者行喉次全切除术。手术范围：切除舌骨，大部分甲状软骨板，会厌前间隙和声带、室带，保留一侧杓状软骨及一侧1／3甲状软骨板、1／3的声带。采用一侧的带蒂皮瓣、对侧带蒂的肌膜瓣修复创面和喉功能重建。结果：全部患者均恢复正常的呼吸、吞咽功能，93．9％拔除气管套管获得发声功能。随访2～5年，3例死于肿瘤以外的疾病，2例死于肿瘤多脏器转移。结论：喉次全切除术后，应用带蒂皮瓣和肌膜瓣修复创面，重建发声功能，具有取材方便、血运好、不易造成喉狭窄、缩短带管时间以及提高患者生存质量等优点。

The reparation of tissular defect and reconstruction of laryngeal function in subtotal laryngectomy with pedicled cutaneous and musculocutaneous flaps

Objective:To explore the recovery of wounded surface and reconstruction of laryngeal function after subtotal laryngectomy.Method:Thirty three cases of subtotal laryngectomy were reviewed for analysis. The hyoid bone, most part of thyroid cartilage and the gap before epiglottis exsected while arytenoids cartilage of one side, 1/3 thyroid cartilage and 1/3 true vocal cord were reserved in the subtotal laryngectomy operation. And pedicled cutaneous flap of one side and pedicled musculocutaneous flap of the other side were used to rehabilitate the wounded surface and reconstruct the laryngeal function.Result:The function of respiration and swallowing resumed in all cases. 93.9 % patients got normal pronunciation function after windpipe casing pulled out. Three year survival rate was 89.3 % and five year survival rate was 78.6 %.Conclusion:The results demonstrated our method has such advantages as follows:being easy to get material, having good vascular circle,laryngeal narrow seldom happened,shortening the time with windpipe casing and improving the quality of life.