喉癌甲状软骨窗式切除带蒂肌瓣修复喉腔术临床研究  

Clinical observation of reconstruction with muscle flaps in partial laryngectomy

作　　者：于锋 焦粤龙 于泓 张浩亮 梁子键 

机构地区：[1]广州市耳鼻咽喉头颈外科医院,510620

出　　处：《中华显微外科杂志》2005年第2期133-135,共3页Chinese Journal of Microsurgery

摘　　要：目的探讨进一步提高中晚期声门型喉癌患者生存率及生存质量的方法。方法回顾分析53例声门型喉鳞状细胞癌实施喉癌甲状软骨窗式切除带蒂肌瓣修复喉腔术临床资料,其中,T2N036例,T2N13例,T3N012例,T3N12例。临床分期,Ⅱ期36例,Ⅲ期17例。使用电刀结合电锯行喉腔肿瘤、甲状软骨窗式切除术,把制备的肌瓣通过开窗口修复喉腔。单蒂肌瓣修复:胸骨舌骨肌26例,带舌骨、胸骨舌骨肌9例,肩胛舌骨肌5例,双侧肩胛舌骨肌修复喉腔8例。双蒂肌膜肌瓣修复:胸骨舌骨肌4例。Kaplan-Meier计算生存率及肿瘤复发趋势。结果3、5年生存率分别为91.9%和84.2%,肿瘤复发5例(T2N03例,T3N01例,T3N01例),肿瘤复发率为11.0%。拔管率为96.2%(51/53),拔管时间为2～4周。发音成功率为100%。结论采用喉癌甲状软骨窗式切除带蒂肌瓣修复喉腔术,基本保留了喉腔的生理形态,修复组织稳定,有利于发音,提高了生存质量。Objective To evaluate the efficacy of laryngeal function-sparing surgery for the patients with glottis cancer while preserving the partial thyroid cartilage. Methods Fifty-three patients with adyanced laryngeal cancers underwent this procedure. In those patients (stageⅡ,36 cases;Ⅲ,17 cases) ,39 cases had stage T2 lesions 14 cases had stage T3 lesions. The reconstruction methods for laryngeal cavity defectrepairing following partial laryngectomy were the use of sternohyoid muscle, bilateral omohyoid muscle flap, and bi-pedicled and bi-muscular flaps of sternohyoid muscle. The median follow-up interval was 24 months. Results The overall 3 and 5 years survival rates estimated according to Kaplan-Meier were 91.9% and 84.2% respectively. The 5-year regional recurrence rates was 11.0% . Decannulation rate was 96.2%. 94.3%(50/53)enjoyed satisfactory phonation, but 5.7% (2/50) showed hoarseness. All patients returned normal swallow funciton. Conclusion The partial laryngectomy is a kind of radical operation with reservation of laryngeal function. It preserved and reconstruction of laryngeal function not only improved local cancer control and the decannulation rate, but also preserves laryngeal physiologic function and improves the quality of life in patients.

关 键 词：肌瓣修复 骨窗 甲状 临床研究 带蒂 胸骨舌骨肌 肩胛舌骨肌 喉鳞状细胞癌 生存质量 5年生存率 肿瘤复发率 喉癌患者 临床资料 回顾分析 临床分期 喉腔肿瘤 拔管时间 修复组织 声门型 中晚期 切除术 拔管率 发音 

分 类 号：R739.65[医药卫生—肿瘤]