【摘要】 目的 觀察全喉全下咽切除術后空腸游離移植術二次手術時同時保留動靜脈血管蒂或僅保留動脈血管蒂時對移植組織的影響。 方法 回顧分析2002年1月-2009年12月4例下咽癌行全喉全下咽切除術空腸游離移植術術后8~18個月因頸部轉移灶出現而需再行手術患者的臨床資料，其中3例行根治性頸清掃，1例行局部包塊擴大切除術。2例同時保留動靜脈蒂，2例僅保留動脈蒂。 結果 4例術后臨床Ⅰ期愈合。保留動靜脈蒂者吞咽功能與術前無異。僅保留動脈蒂者術后1個月仍有頸中份的明顯隱痛，胃腸造影移植空腸段的蠕動明顯減弱，吞咽固體食物時自覺較術前緩慢。 結論 再次手術時保留血管蒂對于保持空腸移植段的活力具有重要的意義。【Abstract】 Objective To observe the effect of keeping arteriovenous or venous pedicles during the second free jejunal transplantation after total laryngopharyngectomy on the transplanted tissues. Methods From January 2002 to December 2009,four patients underwent total laryngopharyngectomy and free jejunal. But 8-18 months later, the patients underwent another operation because of recurrent metastatic mass in the ipsilateral neck side of anastomosis; in whom three underwent radical neck dissection and one underwent local enlarged mass resection. In the four patients, two had arteriovenous pedicles remained and another two kept only venous pedicles. Results All of the four patients experienced first-stage healing. The deglutitive function in the two patients who had received the arteriovenous pedicles preservation didn’t differ much from that before the operation. While vague anguish in the anterior region of the neck, weak peristalsis of the transplanted jejunum, a little discomfort and slow swallowing were found in another two patients. Conclusion Keeping vascular pedicles during re-operation helps make the activity of the transplanted jejunum.