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目的:探索喉内黏膜瓣联合喉模技术对声带前连合粘连的防治效果。方法:动物实验于2019年11月至2021年6月选取25只雄性比格犬，通过COn 2激光损伤比格犬声带前连合制造动物模型，再分别以喉内游离黏膜瓣+喉模（A组）、喉内带蒂黏膜瓣+喉模（B组）、单纯喉模（C组）覆盖创面，另设创面不处理组（D组）和假手术组（E组），每组5只；术后2周拆除喉模，术后4周观察喉镜下表现、声带长度及声门面积。临床应用方面，回顾性分析2019年1月至2021年1月就诊于复旦大学附属华山医院的16例声带前连合病变患者资料，所有患者行喉内黏膜瓣联合喉模技术防治前连合粘连治疗，分为游离黏膜瓣治疗组（10例）和带蒂黏膜瓣治疗组（6例）。2组患者术后每月随访声带粘连情况，术前及术后3个月进行嗓音分析检查。采用SPSS 20.0软件进行数据分析。n 结果:全部25例比格犬手术顺利，术后无并发症。术后4周，相较A、C、D组，B组声带长度长（n H=31.688，n P<0.05），声门面积大（n H=16.444，n P<0.05）；相较C、D组，A组声带长度长（n H=20.936，n P<0.05），声门面积大（n H=11.786，n P0.05），C、D组术后4周较术前声带长度短、声门面积小（n tC组左声带长度=16.137，n tC组右声带长度=13.984，n tD组左声带长度=11.903，n tD组右声带长度=14.587，n tC组声门面积=10.280，n tD组声门面积=22.974，n P值均<0.05）。临床16例前连合病变患者手术顺利，术后随访6~18个月，电子喉镜下全部病例均未出现前连合粘连。术后3个月患者基频微扰（Jitter）、振幅微扰（Shimmer）、噪谐比（NHR）均较术前减低（n t带蒂jitter=24.885，n t带蒂shimmer=22.643，n t带蒂NHR=6.202，n t游离jitter=25.459，n t游离shimmer=18.683，n t游离NHR=5.705，n P值均<0.05），最长发音时间（MPT）较术前改善（n t带蒂=-9.661，n t游离=-20.840，n P值均<0.05）。n 结论:喉内黏膜瓣联合喉模技术能有效防治声带前连合粘连，喉内带蒂黏膜瓣防治效果更佳。“,”Objective:To evaluate the effectiveness of mucosal flap combined with silicone keel for preventing and treating anterior commissure adhesion in canines and clinical cases.Methods:A prospective experiment was performed from November 2019 to June 2021. Twenty five canines were randomly divided into 5 groups(A, B, C, D, E). Group A, B, C, D received anterior commissure injury by COn 2 laser, then separately treated with free mucosal flap-keel complex,intralaryngeal mucosal flap-keel complex, silicone keels and without treatment, group E didn′t injure the vocal cord after intubation. The keel was removed after 2 weeks, the larynx was harvested after 4 weeks. The effectiveness of anterior commissure adhesion prevention was evaluated by manifestation under laryngoscope, standard vocal cord length and standard glottic area. A retrospective analysis was performed on sixteen patients with anterior commissure lesion, who underwent mucosal flap-keel technique in Huashan Hospital of Fudan University from January 2019 to January 2021 (10 cases with free mucosal flap-keel complex and 6 cases with intralaryngeal mucosal flap-keel complex). All the patients underwent evaluation of laryngeal function included manifestation under laryngoscope each month and voice analysis before and 3 month after surgery. SPSS 20.0 software was used for statistical analysis.n Results:No surgery accident or complication happened in canines and patients. The standard vocal cord length and standard glottic area after 4 weeks in group B were significantly higher than those in group A, C, D (n Hstandard vocal cord length=31.688, n Hstandard glottic area=16.444, n P<0.05). The standard vocal cord length and standard glottic area after 4 weeks in group A were also significantly higher than those in group C, D(n Hstandard vocal cord length=20.936, n Hstandard glottic area=11.786, n P0.05). The standard vocal cord length and standard glottic area after 4 weeks in group C, D were significantly lower than those before surgery(n tC left standard vocal cord length=16.137, n tC right standard vocal cord length=13.984, n tD left standard vocal cord length=11.903, n tD right standard vocal cord length=14.587, n tC standard glottic area=10.280, n tD standard glottic area=22.974, n P<0.05). During 6-18 months of follow-up in clinical patients, no one developed a glottic web. Three months after surgery, Jitter, Shimmer, noise to harmonic ratio(NHR), the maximum phonation time(MPT)in all patients were significantly different from preoperative(n tintralaryngeal mucosal flap jitter=24.885, n tintralaryngeal mucosal flap shimmer=22.643, n tintralaryngeal mucosal flap NHR=6.202, n tintralaryngeal mucosal flap MPT=-9.661, n tfree mucosal flap jitter=25.459, n tfree mucosal flap shimmer=18.683, n tfree mucosal flap NHR=5.705, n tfree mucosal flap MPT=-20.840, n P<0.05).n Conclusion:Mucosal flap combined with silicone keel is an effective technique for preventing and treating anterior commissure adhesion. The effect of pedicled intralaryngea lmucosal flap is better.