论文部分内容阅读
目的回顾性分析第四军医大学唐都医院l983年～2001年收治的喉气管狭窄114例,比较肋软骨和摇门式肌皮瓣2种移植物在喉气管狭窄重建中的效果。方法随机采用肋软骨移植喉气管重建术53例,摇门式胸舌骨肌皮瓣移植喉气管重建术55例,复合肋软骨肌皮瓣移植喉气管重建术6例。2种方法都先行喉气管裂开,黏膜下切除瘢痕。肋软骨组:取一侧带软骨膜肋软骨1块,移植于喉气管狭窄区前壁。T形管支撑。肌皮瓣组:在喉气管狭窄区喉气管旁作一双蒂胸舌骨肌皮瓣,翻转180°,肌皮瓣移植于喉气管狭窄前壁,T形管支撑。6例合并颈前壁大瘘,采用复合肋软骨和肌皮瓣移植。结果肋软骨移植组46例(占86.8%)一次手术治愈。7例失败,其中3例伤口感染软骨坏死,2例T形管顶端损伤黏膜形成新狭窄,2例瘢痕体质,再狭窄。肌皮瓣移植组50例(占90.9%)一次手术治愈。5例失败中3例皮瓣下陷入气管腔,2例喉气管内又长瘢痕狭窄。复合肋软骨肌皮瓣移植组6例,4例治愈,2例软骨坏死失败。随访1～10年,肌皮瓣组l例术前病因不清者,术后3年再狭窄,其余疗效巩固。结论2种移植物对喉气管狭窄重建术都有较高治愈率。颈部皮肤血供差者慎用肋软骨移植,颈部皮下脂肪厚者不宜用摇门式肌皮瓣移植,颈前壁有大瘘口者宜采用复合肋软骨肌皮瓣移植。
Objective To retrospectively analyze 114 cases of laryngotracheal stenosis admitted in Tangdu Hospital of Fourth Military Medical University from l983 to 2001 and compare the effects of two kinds of implants of costal cartilage and swinging myocutaneous flap in laryngeal tracheal stenosis reconstruction. Methods Fifty-five cases of laryngotracheal reconstruction with costal cartilage transplantation and 55 cases with swing-door thoraco-hyoid muscle flap transplantation and laryngeal tracheal reconstruction with composite cartilage myocutaneous flap were randomly included. 2 methods are first laryngeal tracheal rupture, submucosal scar removal. Costal cartilage group: Take cartilage cartilage with a piece of the side, transplanted in the anterior wall of the laryngeal tracheal stenosis. T-tube support. Musculocutaneous flap group: A pair of pedicled thoracic musculocutaneous flap beside the laryngotracheal tube in the area of laryngotracheal stenosis was flipped 180 °. The musculocutaneous flap was transplanted to the anterior wall of laryngotracheal tube stenosis with T-tube support. Six cases with anterior cervical fistula, the use of composite costal cartilage and muscle flap transplantation. Results In the costal cartilage transplantation group, 46 cases (86.8%) were cured by one operation. Seven patients failed. Three of the wounds were infected with cartilage necrosis. Two of the T-shaped tracts were damaged by mucosal lesions and two were scarred with restenosis. Fifty cases of myocutaneous flap transplantation (90.9%) were cured by one operation. In 5 cases, the flap flaps into the trachea cavity in 3 cases and the long scar in 2 cases laryngotracheal tube. 6 cases were treated with composite costal cartilage myocutaneous flap, 4 cases were cured and 2 cases were failed in cartilage necrosis. Follow-up 1 to 10 years, muscle flap group l cases of preoperative etiology, who restenosis after 3 years, and the remaining consolidation effect. Conclusion Both implants have higher cure rate for laryngotracheal stenosis reconstruction. Patients with poor neck and neck blood supply should be treated with costal cartilage transplantation. Patients with thick subcutaneous fat in the neck should not be treated with swing-door muscle flap, and there should be a large fistula in the anterior cervical wall.