双蒂双肌瓣在喉部分切除中应用山西省肿瘤医院（０３００１３）康秀水，米玉录，武乃旺自１９８５年以来，为２５例Ｔ３～４各型病变喉癌患者行扩大部分喉切除，应用双蒂双肌瓣重建喉腔。不仅扩大了喉部分切除适应症，而且获得了良好的功能，报道如下。临床资料一、一般情况：２５例中，男２０例，女５例。年龄在４３～６７。声门型１７型，声门上型６例，声门下型２例。组织学检查均为鳞状上皮细胞癌。同期行单侧淋巴结清扫４例，同期行双侧颈淋巴结清扫１例。扩大声门上水平半喉切除６例，３／４喉切除３例，扩大垂直半喉切除１４例，额侧垂直半喉切除２例，双侧双蒂双肌瓣修复１１例，单侧双蒂双肌辨修复１４例，其中３例在日本手术。二、结果：２５例中２１例在术后７天至１０天内拔除胃管。１９例在术后第二天试饮水几乎不呛咳，４例因肺功能欠佳分别在１５～２０天拔除胃管。２５例术后均能正常对话，其中因术后补充放疗。出院时未拔除气管套管，但发音良好，其余１９例均拔除气管套管。手术方法局麻气管切开后改全麻。切口单纯喉切除可取正中直切口或小“Ｕ”形切口；联合根治可取大“Ｌ”；双侧同期清扫用大“Ｕ”形切口。在颈阔肌下分离肌皮瓣后，正中白线裂开带状肌，仔细分离带状肌内侧并保 Two-pedicle double-muscle flap for partial laryngectomy: Shanxi Provincial Tumor Hospital (030013) Kang Xiushui, Mi Yulu, Wu Naiwang Since 1985, 25 cases of laryngeal carcinoma with T3 ~ 4 lesions have undergone extended laryngectomy. Double pedicled double muscle flap reconstruction of the laryngeal cavity. Not only has the indication for partial laryngectomy been expanded, but it has also achieved good function, as reported below. Clinical data First, the general situation: 25 cases, 20 males and 5 females. Age 43 to 67. Glottic type 17, supraglottic type 6 cases, subglottic type 2 cases. Histological examination was squamous cell carcinoma. Unilateral lymph node dissection was performed in 4 patients during the same period, and bilateral cervical lymph node dissection was performed in 1 patient at the same time. Six patients underwent horizontal half-laryngectomy at the supraglottic level, 3/4 throat resection in 3 cases, enlarged vertical hemi-laryngectomy in 14 cases, and frontolateral vertical hemi-laryngectomy in 2 cases. Bilateral double-pedical double-muscle flap repair in 11 cases, unilateral double The pedicle muscles were repaired in 14 cases, of which 3 cases were operated in Japan. Results: Twenty-one of 25 patients were removed from the stomach tube within 7 days to 10 days after surgery. Nineteen patients had almost no phlegm on the second day after the trial, and 4 patients had their gastric tube removed on 15 to 20 days because of poor lung function. All 25 patients were able to have normal conversations after surgery, because of postoperative radiotherapy. No tracheal cannula was removed when discharged, but the pronunciation was good. The remaining 19 cases were all removed tracheal cannula. The surgical method was changed to general anesthesia after local anesthesia. Incision laryngectomy can be taken with a midline incision or a small “U” incision; a combined radical cure is desirable for large “L”; bilateral simultaneous cleansing with a large “U” incision. After separating the myocutaneous flaps under the platysma muscle, the median white line splits the ribbon muscles and carefully separates the inner side of the ribbon muscles.