气管壁缺损的胸锁乳突肌锁骨瓣修复

Tracheal reconstruction by clavicular bone flap pedicled with sternoclei- domastoideus muscle

目的探讨胸锁乳突肌锁骨瓣在修复气管壁缺损中的应用价值。方法1993年11月～2004年5月间采用胸锁乳突肌锁骨瓣治疗的气管离断伤及狭窄共9例,男性8例,女性1例,年龄21～59岁,中位年龄41岁。其中气管完全离断4例,缺失的气管段最短为3.8cm,最长为5.7cm;气管狭窄5例,气管狭窄部位2～5环2例;3～7环1例;4～7环2例。结果术后皮下气肿2例,气管内肉芽生长3例,所有患者均一次性拔除“T”形管,拔“T”形管后无呼吸困难及吞咽困难,8例发音正常,1例轻微声嘶。纤维支气管镜检查重建气管腔均完全上皮化并无明显狭窄。结论胸锁乳突肌锁骨瓣有良好血液供应,手术简便,在同一术野操作,远期疗效好,是目前较为理想的气管狭窄修复重建材料。

OBJECTIVE To investigate the value of application with clavicular bone flap pedicled with sternocleidomastoideus muscle in tracheal reconstruction. METHODS Four cases of tracheal mutilation and five cases of tracheal stenosis were treated by clavicular bone flap pedicled with stemocleidomastoideus muscle.from novermber 1993 to may 2005. RESULTS All patients were successfully decannulated without dispnea and dysphagia .Two subcatanneous emphysemas happened.Granucation in trachea happened to four patients .One patient who trachyphonia can not recovery.After fiberoptic bronchoscopy examination ,all the repaied trachea reached the degree of epithelization. CONCLUSION The procedure is relatively simple and involves single-staged reconstruction. Sternocleidomastoid muscle clavicular bone flap is durable, and will conform to the shape of the trachea, to provide stability to the airway.