联合软组织瓣修复喉癌术后缺损疗效的客观评价  

OBJECTIVE ASSESSMENT OF COMBINED SOFT TISSUE FLAP IN DEFECT REPAIR OF LARYNGEAL CARCINOMA OPERATION

作　　者：孙丰林[1] 于海洋[1] 徐会娟[1] 许荣[1] 王海鹏[1] 夏拥军[1] 王惠忠[1] 

机构地区：[1]淄博市中心医院耳鼻咽喉头颈外科,山东淄博255031

出　　处：《中国修复重建外科杂志》2014年第9期1115-1119,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的采用声门区形态学参数以及嗓音参数客观评价室带下拉联合颈部带状肌肌筋膜瓣修复早期声门型喉癌术后喉腔缺损的疗效。方法2008年1月-2012年12月，收治47例早期声门型喉癌男性患者。年龄60～75岁，平均68．5岁。病程4～11个月，平均7．2个月。根据美国癌症联合会（AJCC）TNM分期标准，T1aN0M0期28例，T1bN0M0期14例，T2N0M0期5例；均累及前联合。喉部分切除术后，采用室带下拉联合带状肌肌筋膜瓣修复喉腔缺损。术前1d及术后1年，应用螺旋CT扫描喉部声门区，测量喉部声带突平面的声门区前后径、两侧声带突间距离（简称声突间距）及声门区软组织厚度，评价联合软组织瓣对喉结构重建后形态的影响；检测嗓音参数基频（F0）、基频微扰（Jitter）、振幅微扰（Shimmer）、声门噪声能量（normalizednoiseenergy，NNE）及最长声时（maximumphonatorytime，MPT），评价联合软组织瓣参与喉发音的效果。结果术后病理检查示，38例为高分化鳞状细胞癌，9例为中分化鳞状细胞癌：切缘均未发现肿瘤。术后7～9d颈部切口愈合；44例于术后9～11d拔除气管套管，3例于3周拔除气管套管。47例患者均在术后3～4d顺利经口进食。患者均获1年随访。术后1年，患者声门区前后径较术前1d显著减小（t=-15．161，P=-0．000），声突间距及声门区软组织厚度手术前后比较差异均无统计学意义（P〉0．05）。术后1年患者Shimmer、NNE及MPT与术前1d比较差异有统计学意义（P〈0．05），F0及Jitter与术前1d比较差异无统计学意义（P〉0．05）。结论室带下拉联合带状肌肌筋膜瓣可有效修复喉部分切除后的喉腔缺损，维持术后有效气道的建立；其不仅对喉形态无显著影响，还可作为新喉的有效发声振动体。Objective To objectively evaluate the effectiveness of the ventricular fold pull-down combined with strip myofascial flap to repair laryngeal defect after early glottic carcinoma operation with glottic morphological parameters and voice parameters. Methods Between January 2008 and December 2012, 47 patients with early glottic carcinoma and anterior commissure involvement underwent partial laryngectomy. All patients were male, aged from 60 to 75 years （mean, 68.5 years）. The disease duration was 4-11 months （mean, 7.2 months）. According to American Joint Committee on Cancer （AJCC） TNM criteria, 28 cases were classified as T1aN0M0, 14 cases as T1bN0M0, and 5 cases as T2N0M0. Laryngeal defect after resection of tumor was repaired by ventricular fold pull-down combined with strip myofascial flap. At 1 day before operation and at 1 year after operation, multilayer spiral CT was used to scan larynx, to measure and compare the anteroposterior diameter of vocal area, the distance between both sides of the vocal process, and the thickness of soft tissue of vocal area, and the effect of combined soft tissue flap was objectively assessed in laryngeal morphology reconstruction. The actual voice parameters [including F0, Jitter, Shimmer, normalized noise energy （NNE）, and maximum phonatory time （MPT）] were tested and compared, and the effect of the combined soft tissue flap on postoperative laryngeal pronunciation was evaluated. Results Postoperative pathological examination revealed well-differentiated squamous cell carcinoma in 38 cases, and moderately-differentiated squamous cell carcinoma in 9 cases; no tumor was found in the resection margin. Healing of neck incision was obtained in all patients at 7-9 days after operation. Forty-four cases were decannulated at 9-11 days after operation and the remaining 3 cases were decannulated at 3 weeks after operation. Oral feeding usually started in all cases at 3-4 days after operation. All patients were followed up 1 year. At 1 year after operation, the antero

关 键 词：声门型喉癌 喉部分切除术 喉腔缺损修复 声学分析 声门区形态 

分 类 号：R739.65[医药卫生—肿瘤]