会厌及胸锁乳突肌肌骨膜瓣修复喉气管狭窄

The Application of Epiglottis and Sternocleidomastoid Muscle Periost Valves on Repairing laryngotracheal Stenosis

目的 :介绍会厌及胸锁乳突肌肌骨膜瓣在修复喉气管狭窄中的疗效和应用价值。方法 :切除喉气管狭窄后利用会厌及胸锁乳突肌肌骨膜瓣修复喉气管缺损。结果 :2 0例中 1 9例一期愈合 ,1例不能拔管 ,拔管率 95 % ;术后 7～ 1 5d取出扩张子 ,术后 2 0～ 80d开始堵管 ,平均 4 6d拔除气管套管 ;术后 1 6d拔鼻饲管。声门区狭窄有不同程度的发音嘶哑。声门下及颈段气管狭窄的发音正常。 5例分别于术后 1 2个月行CT检查 ,可见修补的锁骨膜有明显的骨化。结论 :会厌及胸锁乳突肌肌骨膜瓣具有丰富的血供 ,材料坚固柔韧 ,外形呈拱形非常适合喉前侧壁及气管的弧度。材料的气道面有正常黏膜覆盖 ,防止肉芽组织生长 ,并能抵抗呼吸压力变化 ,不塌陷 ,远期疗效好 ,是目前较为理想的喉气管狭窄修复重建材料。

Objective:To introduce the ifficacy and value of application of epiglottis and sternocleidomastoid muscle periost valves in repairing laryngotracheal stenosis.Methods:Epiglottis and sternocleidomastoid muscle periost valves were used to repair throat deletion after resecting narrow laryngotrachea.Results:19 cases were primary healing in 20 cases.The tube could not be plucked away in 1 case.The rate of decannulation was 95%.Postoperative dilator was took out between 7 and 15 days and Wind pipe was occluded between 20 and 80 day.The mean postoperative time of decannulation from nastles and trachea was 46 and 16 days,respectively.There were different phonetic hoarseness of glottic stenosis.The phonation of subglottic and cervical tracheostenosis was normal.5 clavicular periosteal ossification were detected by CT postoperative 12 months.Conclusion:Epiglottis sternocleidomustoid muscle periost valve has rich blood supply,solid material and suitable arch similar to that of anterior-lateral larynx or thachea.The valve within normal musoca preventing granulation and resisting pressure change with aspiration is an idea material for larynogotrachea.The method has better late effect.