颈阔肌肌筋膜瓣行喉重建的疗效观察

目的探讨颈阔肌肌筋膜瓣在喉重建术中的临床应用价值。方法观察了７２例喉癌切除术后应用颈阔肌肌筋膜瓣修复缺损的临床效果。手术时根据癌肿的大小与部位行喉部分、扩大喉部分或次全喉切除术，沿颈浅筋膜层将颈阔肌连同其筋膜与皮下组织分开，根据缺损的大小，切制相应的单蒂颈阔肌肌筋膜瓣并转入术腔修补缺损。结果经３年以上的随访，术后７～１０天拔除胃管，气管套管拔除率９１．７％（６６／７２）；３年生存率８４．７％（６１／７２）；复发率１１．１％（８／７２）；发生喉瘘４例（５．６％），喉瘢痕狭窄２例（２．７％）。结论颈阔肌肌筋膜瓣是喉重建的良好材料。

Observation on Effect of the Reconstruction of Larynx with Platysma Myofascial Flap

Obiective To explore the clinical value of the platysma myofascial flap in the reconstruction of larynx.Method 72 cases with Laryngocarcinoma were undergone laryngectomy and larynyeal reconstruction by the use of platysma myofascial flap.According to the size and location of the tumor,partial.extended partial,subtotal laryngectomy had been performed.Then skin flap was pulled and separated carefully between the platysma myofascia and subcutaneous tissue.According to the size and shape of laryngeal defect,a unipedicle platysma myofascial flap was taken and transposed into the lumen to cover the defect.Results After operation,a three year follow up indicated that the swallow function returned to normal in 7 to 10 days,the tracheal tube extraction rate was 91.7%(66/72),the 3 year survival rate was 84.7%(61/72),recurrence rate was 11.1%(8/72),Laryngeal fistula 5.6%(4/72),laryngostenosis 4.2%(3/72).Conclusion The playsma myofascial flap was feasible for laryngeal reconstruction.