梨状窝癌喉下咽切除残喉瓣修补下咽缺损  

Remaining laryngeal flap reconstruction of the hypopharynx in pyriform sinus carcinoma resection

作　　者：柳斌[1] 潘子民[1] 季文樾[1] 

机构地区：[1]中国医科大学附属第一医院耳鼻咽喉科,沈阳110001

出　　处：《临床耳鼻咽喉科杂志》2006年第6期241-242,共2页Journal of Clinical Otorhinolaryngology

摘　　要：目的：探讨梨状窝癌喉下咽切除术后应用残喉瓣修补下咽缺损的可行性。方法：应用残喉瓣修补梨状窝癌喉下咽切除术后下咽缺损7例。术中切除患侧半咽和半喉，保留健侧半喉，剔除甲状软骨、环状软骨及杓状软骨，将软骨内膜保留于喉瓣上，形成一个与健侧舌根有宽广基蒂的大小约4．0cm×2．0cm的喉瓣，术中保留健侧的舌骨下肌群，勿损伤健侧喉上动脉。下拉舌根与咽侧壁上方切缘缝合，喉瓣切缘与下咽后壁及食管入口上方切缘缝合。术后均行放疗，剂量为60Gy。结果：术后6例患者一期愈合；1例患者出现局部感染和咽瘘，经局部换药2周内愈合。全部患者吞咽功能良好。7例术后随访3～5年，3年内死亡3例，4年内死亡1例。结论：对于适合的梨状窝癌患者，应用残喉黏膜瓣修补下咽缺损具有操作简单，安全可靠，损伤小，并发症少的优点。Objective：To discuss the feasibility of using remaining laryngeal flap to reconstruct the hypopharyngeal defect in pyriform sinus carcinoma resection. Method： Seven patients with pyriform sinus carcinoma to reconstruct hypopharyngeal defect with remaining laryngeal flap were summarized. Half the hypopharynx and half the larynx were resected and unaffected half the larynx was reserved,＂ On the unaffected side, thyroid, cricoid and arytenoid cartilages were removed and inner perichondrium was reserved. A 4.0 cm× 2.0 cm laryngeal flap was made with a broad base on the base of tongue. Subhyoid muscles on unaffected side were reserved and superior laryngeal artery should not be injuried, The food canal was reconstructed with the pulleddown mucosa of the base of the tongue, the unaffected half of the larynx and the remnant hypopharyngeal mucosa. Postoperative radiation （60 Gy） was undertaken. Result： Six cases healed normally, Local infection and pharyngeal fistula were found in one case and cured in two weeks. No hypopharyngeal stenosis was observed. Through three to five years followup of the seven patients, three died in three years and one died in four years. Conclusion：To the selected cases with pyriform sinus carcinoma, reconstruction of hypopharyngeal defect with laryngeal flap is simple and safe. The injury is relatively small and complications are not severe, In the case sufficient blood supply is insured, firm suture is the key point to prevent pharyngeal fistula.

关 键 词：下咽肿瘤 下咽缺损 修复术 

分 类 号：R739.63[医药卫生—肿瘤]