咽侧径路水平喉部分切除术19例报告  

Lateral parapharygeal approach to horizontal partial laryngectomy and its functional significance

作　　者：秦照军[1] 陈莉莉[1] 

机构地区：[1]苏州大学附属第一医院耳鼻咽喉科,苏州215006

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第18期1423-1425,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的探讨咽侧径路水平喉部分切除手术的技术操作、疗效及该径路积极的临床意义。方法：收集2000-2008年间咽侧径路水平喉部分切除术19例患者的临床资料，ll例声门上型，8例下咽上型（其中1例侵犯舌体，2例侵犯舌根扁桃体软腭，2例侵犯下咽侧后壁）；其中术中采用直接缝合12例，甲状软骨膜3例，胸锁乳突肌肌皮瓣1例，胸大肌肌肌皮瓣修复3例。术后根据需要给予放射治疗。结果：19例患者全部拔出气管套管，16例一期拔管，拔管后呼吸通畅；发声良好，无1例发生咽瘘；1例术后6个月仍有轻度误吸，1例术后1年突然咽部大出血死亡，2例术后颈总动脉转移出血死亡，4例术后2年内复发，3例3～5年内复发；3年生存率78．9％，5年生存率57．9％。结论：咽侧径路水平喉部分切除术损伤相对小，功能恢复快，为较好的手术方式。Objective:This article was designed to evaluate Lateral parapharygeal approach to horizontal partial laryngectomy.Method:In a retrospective review of 19 patients with carcinoma of the supraglottic larynx were admitted from2000 to 2008.Eight patients with extension of tumor into the vallecula,piriform sinus,falsevocal cords,arytenoid or base of the tongue.Two patients with extension into tonsil and soft palate.The principal considerations in the decisionmaking algorithm regarding surgical management of a patient with carcinoma of the larynx are the history and physical examination,including assessment of the extent of the primary tumor,evaluation of the cervical lymphatics,and estimation of the patient′s underlying cardiopulmonary reserve.Every patient should undergo electrolaryngoscope and as part of the preoperative evaluation.Further evaluation should also include assessment of the entire upper aerodigestive tract to rule out a synchronous second primary carcinoma.Imaging with either CT or MRI is now generally accepted to be more sensitive than physical examination.They have been demonstrated to be excellent aids in the identification of tumor extension.Histologic confirmation shoud be proceeded.Tumors were excised through the Lateral parapharygeal approach,were combined with neck dissection.In most cases mucosal defects of the lateral pharyngeal wall may be closed by primary closure,but some cases simultaneously needs to be supplemented with reconstruction depending on the location and extent of resection(the pectoralis major myocutaneous flaps in 3patients,the sternocleidomastoidensmyocutaneous flaps in 1patient and the membrane of thyroid cartilage flap in 3patients).Result:The operations were successful in all cases.The survival rate of flaps was 100%in all patient.All cases got good outcome of swallow and speech without pharyngocutaneous fistula,recurrence in 7patients were found after 6-60 months follow up,included 2patients dead at 23 months because of metastas and 1patients dead at 11 months because o

关 键 词：舌根肿瘤 声门上型喉癌 咽侧入路 手术 水平喉部分切除术 

分 类 号：R739.65[医药卫生—肿瘤]