垂直半喉切除咽下缩肌甲状软骨膜瓣修复术疗效分析  

The Repair of Infraconstrictor Thyroid Cartilage Osteoperiosteal Flap in Vertical Hemi-laryngectomy for Laryngocarcinoma

作　　者：熊国平 陈永兴 谢巍巍 张卓成 XIONG Guo-ping;CHEN Yong-xing;XIE Wei-wei;ZHANG Zhuo-cheng(Department of Otolaryngology,Jiangmen Center Hospital,Jiangmen 529000,Guangdong,China)

机构地区：[1]广东省江门中心医院耳鼻咽喉科,江门529000

出　　处：《中国现代手术学杂志》2018年第4期298-300,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨垂直半喉切除咽下缩肌甲状软骨膜瓣重建喉功能的效果。方法随机选取早中期喉癌(声门型T1-3N0-1M0)患者85例,术前均行病理活检、纤维喉镜检查及喉部增强CT扫描明确诊断,并一期行垂直半喉切除咽下缩肌甲状软骨膜瓣修复术。术后随访复查纤维喉镜,统计术后拔管情况、皮瓣粘膜上皮化时间、术后发音情况及并发症。结果术后随访0. 5～5年,85例患者术后均成功拔管,拔管率为100%;术后喉腔出现肉芽者12例,发生率为14. 1%;术后皮瓣完全上皮化时间为3～4个月;无一例患者出现喉狭窄需行二次手术,无一例患者死亡。术后患者发音良好,均能正常进食及进行日常的言语交流。结论咽下缩肌甲状软骨膜瓣以咽下缩肌为蒂,甲状软骨膜为修复面,具有取材方便、易旋转、血运好及粘膜上皮化快的特点。以此为皮瓣进行喉功能重建,可有效提高术后拔管率,降低喉狭窄发生率,提高发音质量,改善患者术后的生存质量。Objective To explore the effect of the reconstruction of laryngeal function by infraconstrictor thyroid cartilage osteoperiosteal flap repair in vertical hemi-laryngectomy for laryngocarcinoma. Methods 85 cases with early metaphase laryngeal cancer （glottis T1-3 n0-1 m0） were randomly selected. All patients were performed preoperative pathological biopsy, fiber laryngoscopy and laryngeal enhanced CT scanning diagnosis, and repaired by inferior thyroid perichondrium flap after vertical hemi-laryngectomy. The extubation time and rate, the flap mucosal epithelialization time, postoperative pronunciation and complication were observed after the surgery. Results All cases were followed up for six months to five years. 85 patients were successfully pulled out after surgery, and the catheter rate was 100%. There were 12 cases of granulation in the laryngeal cavity after surgery, and the incidence rate was 14.1%. The total epithelialization time of the flap was 3 to 4 months. None of the patients were carried out a secondary operation, and none of the patients died. All cases achieved good pronounce, normal eating and daily verbal communication. Conclusions Pharyngeal constrictor flap is a kind of soft periosteum, which has the characteristics of convenient, easy rotation, good blood transport and quick mucosal epithelialization. It can improve the extubation rate, reduce the incidence of laryngeal stenosis and improve the quality of speech and survivorship in laryngeal function reconstruction for the laryngocarcinoma patients underwent vertical hemi-laryngectomy.

关 键 词：喉肿瘤 喉功能重建 外科皮瓣 

分 类 号：R739.65[医药卫生—肿瘤]