跨声门癌扩大部分喉切除术重建方法与疗效评价  

A clinical evaluation on reconstruction in extended partial laryngectomy for transglottic cancer

作　　者：赵舒薇[1] 叶青 孙爱华[1] 王海青[1] 郎军添[1] 林顺涨 吴建[1] 范静平[1] 廖建春[1] 彭玉成[1] 陆书昌[1] 萧璧君[1] 

机构地区：[1]上海第二军医大学长征医院耳鼻咽喉科,200003

出　　处：《中华耳鼻咽喉科杂志》2001年第3期216-219,共4页Chinese Journal of Otorhinolaryngology

摘　　要：目的　探讨跨声门癌在保证根治肿瘤的前提下恢复喉的发音、呼吸、吞咽防护功能。方法　对 41例跨声门癌施行扩大部分喉切除术 ,包括扩大垂直喉切除术 2 6例 (2 6 /41) ,扩大额侧喉切除术 5例 (5 /41) ,次全喉切除术 10例 (10 /41)。主要应用胸骨舌骨肌、颈阔肌双蒂转门肌皮瓣等同期进行缺损喉腔的重建。其中应用转门肌皮瓣修复 2 7例 ,胸骨舌骨肌瓣修复 7例 ,舌骨肌瓣修复 5例 ,胸锁乳突肌和筋膜修复 2例。结果　总的 3年、5年生存率分别为 85 .7% (30 /35 )、74.1% (2 0 /2 7) ,III期患者 3年、5年生存率分别为 84.6 % (2 2 /2 6 )、76 .2 % (16 /2 1) ,IV期患者分别为 3/4、1/2。总的气管套管拔出率为 87.8% (36 /41) ,应用颈前转门肌皮瓣修复组拔管率为 96 .3% (2 6 /2 7) ,胸骨舌骨肌瓣为5 /7,舌骨肌瓣为 4/5 ,胸锁乳突肌瓣为 1/2。全部患者恢复了发音功能 ,语音响亮清晰者 92 .7% (38/41) ,吞咽防护功能全部恢复。结论　中、晚期跨声门癌选择性地施行功能保全性喉手术是可行的 ;Objective Transglottic cancer has been a definite indication for total laryngectomy in decades, compromising function of the larynx. The purpose of this study is to present a new radical surgery of extended partial laryngectomy and reconstruction to restore the essential function of larynx. Methods Forty one cases of transglottic cancer were treated by extended vertical laryngectomy (26/41), extended frontolateral laryngectomy (5/41) and subtotal laryngectomy (10/41); the defects of larynx were reconstructed by rotary door myocutaneous flap in twenty seven cases, by sternohyoideus flap in seven cases, by osteomuscular flap in five cases and by sternocleidomastoid flap in two cases. Results The 3 and 5 year survival rates were 85.7% (30/35) and 74.1% (20/27) respectively, those for stage III were 84.6% (22/26) and 76.2% (16/21), for stage IV were 3/4 and 1/2 respectively. All cases resumed acceptable voice, 92.7%(38/41) and enjoyed satisfactory phonation. The over all decannulation rate was 87.8%(36/41), those with rotary door myocutaneous flap was 96.3%(26/27), with sternohyoideus flap was 5/7, with osteomuscular flap was 4/5 and with sternocleidomastoid flap was 1/2. All patients had normal swallow function. Conclusion Extended partial laryngectomy is a kind of radical operation in selected cases of transglottic cancer. The method of reconstruction with rotary door myocutaneous flap can improve curative effect and the essential functions of the larynx.

关 键 词：喉肿瘤 喉切除术 外科皮瓣 跨声门癌 

分 类 号：R739.65[医药卫生—肿瘤]