原位翻转胸骨舌骨肌筋膜瓣修复喉部分切除术后缺损的疗效分析

In situ turnover sternohyoid fasciomuscular flap in the reconstruction of laryngeal defects after partial laryngectomies

目的探讨原位翻转胸骨舌骨肌筋膜瓣(in situ turnover sternohyoid fasciomuscular flap,ITSF)修复喉部分切除喉部缺损的可行性和效果。方法采用ITSF对因喉癌、喉咽癌实施喉部分切除术所致的喉部分缺损进行修复,观察其重建喉结构和功能的效果。结果共实施197例不同类型的喉部分切除术,同时采用ITSF一期修复喉缺损,重建喉结构,恢复喉功能。术后3例(1.5%)患者发生肌筋膜瓣坏死,其中2例坏死的ITSF自行排除,形成喉狭窄不能拔管,但保留了发音功能,另1例通过清创、抗感染和喉全切除治愈,但丧失了喉功能,其余194例患者ITSF修复手术均获得成功,喉功能得到不同程度恢复。术后初次拔除气管套管173例(89.2%),21例(10.8%)患者初次未能拔除气管套管。初次拔管后再狭窄18例,经过支撑喉镜下激光手术治愈10例,其余8例未能拔除气管套管。在手术成功的194例患者中,总拔管率为85.1%(165/194)。结论ITSF是一种简便、易行和可靠的修复喉部分缺损的方法。

OBJECTIVE To explore the role of in situ turnover sternohyoid fasciomuscular flap （ITSF）in the reconstruction of laryngeal defects resulted from partial laryngectomies. METHODS ITSF was used to repair the defects after different partial laryngectomies in 197 patients suffered from laryngeal and hypopharyngeal carcinomas,and outcomes of structural and functional restorations of larynx were evaluated. RESULTS Flap necrosis occurred in 3 cases,2 of which exhibited larygeal stenisis after exclusion of the necorsed flap, and 1 of which was cured with a revised total laryngectomy. In the remainning 194 cases, the structure and function of the larynx were restrored satifactorily, with good voice rehabilitation after surgery. The primary decannulation rate in these patients was 89.2% （173/194） , with 21 （10.8%） patients having difficulties in the primary removal of their tracheotomy tubes. Post-decannulation laryngeal stenoses occurred in 18 patients, which were relieved by transoral laser surgery in 10 cases. The total decannulation rate reached 85.6% in the present series. CONCLUSION ITSP is a simple and reliable recnonstructive option in the repairment of laryngeal defects inccurred from partitial laryngectomies.