摘要
目的 探讨喉扩大切除术后喉功能重建的方法。方法 1998年 9月～ 1999年 10月 2 2例经过选择的T2、T3期声门型喉癌 ,行喉扩大切除术后将会厌部分下移和颈前带状肌修复喉腔和喉支架 ,重建喉功能。根据病情分别行同期同侧或双侧分区性颈清扫术 ,术后行放射治疗。结果2 0例术后 2 0d内恢复正常饮食 ;拔除气管套管 ,恢复了喉的全部功能 ,拔管率 90 9% (2 0 / 2 2 )。 1例咽瘘 ,1个月后恢复经口进食 ;1例再次手术后恢复正常饮食。全部患者发音清晰 ,术后 1～ 6个月纤维喉镜检查 ,2 0例喉入口形成括约瓣。Ⅱ期和Ⅲ期的 3年生存率分别为 9/ 9和 92 3% (12 / 13)。 1例 3年后对侧声带肿瘤复发 ,行喉全切除术。结论 应用会厌部分下移修复支架 ,可扩大喉腔和重建喉入口 ,减轻会厌下拉时的张力 ,避免损伤黏膜。颈前带状肌修复喉腔 ,弥补只用会厌整复喉腔和支架材料不足的缺点 ,而且取材方便 ,组织丰富。二者联合应用 ,对恢复喉功能和提高喉癌患者的生活质量有一定的作用。
Objective To evaluate the methods of reconstruction of laryngeal function after the extended laryngectomy. Methods The laryngeal functions were reconstructed after the extended laryngectomy performed on 22 cases with the laryngocarcinoma of T2 and T3 stages of glottic type, using epiglottis and cervical anterior muscle to reconstruct the laryngeal cavity and larynx bracket, from September 1998 to October 1999. Results Twenty cases recovered normal swallow function in 20 days post-operation as well as the entire function of larynx was recovered, and the rate of decannulation was 90.9% (20/22). One case with pharyngeal fistula recovered a month later, but the other case recovered to normal diet by operation repaired. All the patients pronounced clearly and were able to keep the characteristics of their own voice. The fibred laryngoscope examination showed that the sphincter valves were formed at the larynx atrium in all postoperative cases. The rate of 3-year survival for T2 and T3 stages was 100% (9/9) and 92.3% (12/13), respectively. Conclusion The laryngeal cavity could be enlarged and the laryngeal atrium was reconstructed by employing epiglottis ifraplacement and cervical anterior muscle to reduce the tension of epiglottis and minimize the injury of the membrane as well as to overcome the shortcomings of insufficient material if mere employing epiglottis. The application of combined methods to reconstruct the laryngeal cavity is a practical way to restore the larynx function and improve the life quality.
出处
《中华耳鼻咽喉科杂志》
CSCD
北大核心
2003年第6期430-433,共4页
Chinese Journal of Otorhinolaryngology
