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目的探讨采用颏下岛状皮瓣修复全喉切除术后咽瘘的手术方法及疗效。方法2002年7月-2006年2月,收治9例全喉切除术后咽瘘男性患者。年龄52～71岁,平均61.8岁。喉癌术后7例,下咽癌术后2例。病理检查均为鳞状细胞癌。咽瘘出现时间为全喉切除术后5～62d,平均14.7d。均经25～46d保守治疗无效。术中见内瘘口直径为1.9～4.1cm。采用大小为2.5cm×2.4cm～4.6cm×4.0cm的颏下岛状皮瓣修复咽瘘,术后留置胃管。供区皮肤经松解游离后直接拉拢缝合。结果术后皮瓣均顺利成活;供区Ⅰ期愈合,无明显瘢痕。1例有术前放疗史患者于术后10d再次出现瘘口,对症处理后愈合;其余患者均一期修复成功。患者术后14～22d拔除胃管并经口进食,均无吞咽梗阻感。9例均获随访,随访时间10～38个月,平均27个月。患者颈部外形恢复满意,咽腔内无胡须生长。结论颏下岛状皮瓣具有距咽瘘口近、血供丰富、切口隐蔽、成活率高等优点,是修复全喉切除术后咽瘘的较好方法之一。
Objective To investigate the surgical method and effect of submental laryngeal fistula using submental island flap. Methods From July 2002 to February 2006, 9 male patients with pharyngeal fistula after total laryngectomy were treated. Age 52 ~ 71 years old, average 61.8 years old. Seven cases of laryngeal cancer, two cases of hypopharyngeal cancer after surgery. Pathological examination is squamous cell carcinoma. Pharyngeal fistula appeared after total laryngectomy 5 ~ 62d, an average of 14.7d. After 25 ~ 46d conservative treatment ineffective. Intraoperative see fistula diameter of 1.9 ~ 4.1cm. The submental island flap with the size of 2.5cm × 2.4cm ~ 4.6cm × 4.0cm was used to repair the pharyngeal fistula, and the gastric tube was placed after operation. The skin for the release of the skin directly after the loose suture. Results The flaps survived successfully. The donor site was healed in the first phase with no obvious scar. One patient had a history of preoperative radiotherapy in patients with fistula again after 10d, healed after symptomatic treatment; the rest of the patients were repaired in one phase. Patients 14 ~ 22d after removal of the gastric tube and oral intake, no sense of swallowing obstruction. All the patients were followed up for 10 ~ 38 months with an average of 27 months. Patients satisfied with the recovery of the neck shape, no beryllium growth. Conclusion The submental island flap has the advantage of being close to the pharyngeal fistula, rich in blood supply, hidden incision and high survival rate. It is one of the better methods to repair pharyngeal fistula after total laryngectomy.