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目的 探讨局部张力随意皮瓣修复大型气管缺损.方法 从2015年4月至2017年10月,采用改良设计的颈部张力随意皮瓣二期修复10例甲状腺癌患者术后气管壁的大型缺损.沿缺损的纵轴方向,在其外上方45°角设计两块随意皮瓣,分别翻转和侧转双层修复缺损,修复皮瓣向外向上形成一定张力.术后随访观察气管修复情况、呼吸、语言功能.结果 10例患者大型气管壁缺损,均一次获得成功修复,并很快恢复了正常呼吸、语言功能.随访6 ～ 30个月,中位随访时间12个月,气管保持正常通气呼吸功能,无肿瘤复发,1例肺转移患者疾病仍处稳定.结论 改良设计的颈部张力随意皮瓣能简单、快捷、有效地解决某些气管较大缺损的修复难题.

Objective To investigate a simple and practical method for the repair of large tracheal defects.Methods From April 2015 to October 2017,10 patients with large tracheal wall defects after thyroid carcinoma underwent two phase repair with cervical tension free flap with modified design.In the longitudinal direction of the leakage,design two pieces of random flap outside the top angle of 45°,respectively,and the side turn double flip flap to repair the leak,outward and upward forming tension,avoid collapse after healing.Results Large tracheal wall defects in 10 cases were successfully repaired,and normal respiration and language functions were recovered quickly.With following-up of 6-30 months (the medran was 12 months),the airway kept normal ventilation,no recurrence,and 1 patient with pulmonary metastasis had a stable condition.Conclusion The modified tension free flap can be used for the repair of large defects of trachea with a good efficacy.