颈部舌形皮瓣在喉全切除术气管造瘘中的应用

The clinical application of cervical tongue-shaped flaps in tracheal stoma after total laryngectomy

目的研究颈部舌形皮瓣在喉全切除术气管造瘘中的临床应用及其优越性。方法在颈部"U"形切口的下方做一舌形皮瓣,在气管造瘘时,只需稍加分离气管与食管,将此皮瓣向后翻与气管后壁黏膜缝合;气管断端前壁可切去少许,缝合于造瘘口下方皮肤。结果缝合后之气管外口可达或者大小约3.0cm×2.5cm,全部病例随访1年～4年半。术后气管外口逐渐缩小,但多数回缩到一定程度后稳定,大约半年至1年后缩至2.0～1.8cm后固定,不再继续缩窄。术后造口及周围皮肤平坦,一直不需配戴气管套管。结论该方法术中操作方便,具有极大的优越性,能够减轻患者的痛苦,降低治疗费用,提高治愈率。

To study the clinical application and its advantage of cervical tongue- shaped flap in tracheal stoma after total laryngectomy. METHODS Atongue-shaped flap was retained underneath the U-shape incision in front of the neck. When tracheal stoma was made, the tongue-shaped flap was sutured with the mucous membrane of tracheal posterior wall. A little bit tissue of tracheal anterior wall in the broken end could be cut off and sutured with the skin under the tracheal stoma. RESULTS The diameter of the tracheal stoma was or not less than 3.0 cm×2.5 cm after operation. All the cases were followed up for 1 to 4.5 years after surgery. The tracheal stoma of all the cases grown downwards to 2.0-1.8 cm after a half to one year and then maintained invariably. The tongue-shaped flap and the skin around the tracheal stoma maintained smooth. It was not necessary for the patients to wear the trachea cannulas. CONCLUSION This method has lots of advantages such as less pain, lower medical cost and the increased recovery rate.