线型闭合器在喉全切除术中的应用  

Use of a linear stapler device in total laryngectomy

作　　者：刘学奎[1] 李浩[1] 刘巍巍[1] 李秋梨[1] 李铨[1] 张欣睿[1] 张星[1] 郭朱明[1] 曾宗渊[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心头颈科,广州510060

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第7期587-590,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广东省科技计划项目资助（20118031800221）

摘　　要：目的评价线型闭合器在喉全切除术中关闭喉咽腔黏膜的临床应用价值。方法2010年8月至2011年12月16例喉癌患者行喉全切除术中应用线型闭合器关闭喉咽腔黏膜，其中放疗后未控2例，放疗后复发4例，初治10例。当线型闭合器关闭喉咽腔黏膜后，将亚甲蓝液体从鼻咽通气管注入喉咽腔，检查吻合口有无渗漏。结果16例患者术中喉咽腔注入亚甲蓝检查吻合口，15例无渗漏；1例有轻微渗漏，缝合后愈合良好，术后未发生咽瘘。无患者中转开放手术。所有患者外科切缘均为阴性。1例放疗70Gy后失败的患者出现轻微咽瘘，保守治疗后痊愈。应用线型闭合器关闭喉咽腔黏膜与传统手工缝合相比，可以节省手工缝合喉咽腔的手术时间大约45min，咽瘘发生率为6．25％（1／16）。结论用线型闭合器关闭喉咽腔黏膜操作简单、可靠、实用，避免手术野的污染，节省手术时间，降低咽瘘发生率，值得临床推广应用。Objective To evaluate the value of using a linear stapler device for the cloure of the pharynx during total laryngectomy. Methods Sixteen total laryngectomies were performed between August 2010 and December 2011, during the operation, the TA 60 linear stapler was used for pharyngeal closure. Among these patients, two patients had the history of pre-operative radiotherapy, four patients recurred after radiotherapy, ten patients were treated for the first time. 100 ml methylene blue was injected into the newly closed laryngopharyngeal cavity through the nasopharyngeal breather pipe for checking up whether it was watertight or not. Results Among the sixteen patients, methylene blue leakage from the mucosal joint of the gular cavity closed by the stapler were not found in fifteen patients, it was only found in one patient. The transudatory places were sutured with absorbable Vicryl sutures. This patient healed well without pharyngocutaneous fistula. Negative surgical margins were achieved in all patients. No patient needed to be tranfered to open surgery. Using a linear stapler device in total laryngectomy, 45 minutes could be saved as compaired to manual suture. One patient developed a light pharyngocutaneous fistula. The incidence of pharyngocutaneous fistula was 6. 25% （1/16）. Conclusions This stapled closed technique for pharyngoplasty is efficient, eliminates the risk of wound contamination, saves operation time and decreases the incidence of pharyngocutaneous fistula. This technique can be recommended as alternative for repairing the pharynx in patients undergoing total laryngectomy.

关 键 词：喉切除术 外科缝合器缝合 手术后并发症 咽 瘘 喉肿瘤 

分 类 号：R739.65[医药卫生—肿瘤]