应用胸骨舌骨肌联合会厌-舌骨固定术重建喉垂直部分切除术后喉功能  

Reconstruction of Larynx Function Using Sternohyoid Muscle and Cricohyoidoepiglottopexy after Vertical Partial Laryngectomy

作　　者：窦明亮 罗晓[1] 兰小娇 兰艳丽[1] 徐开伦 张萌[3] 唐正琪[4] 刘冬梅[2] Dou Mingliang;Luo Xiao;Lan Xiaojiao;Lan Yanli;Xu Kailun;Zhang Meng;Tang Zhengqi;Liu Dongmei(Department of Otolaryngology-Head, and Neck Surgery, Chengdu Fifth People s Hospital, Chengdu 611130, Sichuan , China;Department of Otolaryngology-Head and Neck Surgery, Guangyuan Central Hospital, Guangyuan 628000, Sichuan, China;Department of Otolaryngology-Head and Neck Surgery, People,s Hospital of Deyang City,Deyang 618000, Sichuan , China;Department of Otolaryngology-Head and Neck Surgery,Zigong Third People' 5 Hospital, Zigong 643020, Sichuan, China ( Tang Zhengqi)

机构地区：[1]成都市第五人民医院耳鼻咽喉头颈外科,成都611130 [2]广元市中心医院耳鼻咽喉头颈外科,四川广元628000 [3]德阳市人民医院耳鼻咽喉头颈外科,四川德阳618000 [4]自贡市第三人民医院耳鼻咽喉头颈外科,四川自贡643020

出　　处：《肿瘤预防与治疗》2019年第3期253-258,共6页Journal of Cancer Control And Treatment

基　　金：四川省医学科研课题基金(编号:S16033)~~

摘　　要：目的:探讨胸骨舌骨肌联合会厌-舌骨固定术在喉癌患者喉垂直部分切除术后喉功能重建中的应用价值。方法:对122例于2011年1月至2013年12月多中心募集的T2N0M0声门型喉癌患者行喉垂直部分切除术,并应用胸骨舌骨肌联合会厌-舌骨固定术重建喉功能,同期行单侧或双侧分区性颈淋巴结清扫术。分别于术后1周和术后3月对患者作喉功能评估。结果:吞咽功能:I级者109例(109/122),占89.3%;II级者7例(7/122),占5.7%;III级者6例(6/122),占5.0%。拔管率:所有患者顺利拔管,未出现喉狭窄,拔管率100%。呼吸功能:I级者12例(12/122),占9.8%;II级者77例(77/122),占63.1%;III级者33例(33/122),占27.1%。发音功能:II级者96例(96/122),占78.6%;III级者26例(26/122),占21.4%。kaplan Meier法计算3年生存率为93.3%,5年生存率为89.8%,3、5年生存率比较无统计学差异(χ~2=0.411,P>0.05)。结论:应用胸骨舌骨肌联合会厌-舌骨固定术重建喉垂直部分切除术后喉功能,具有拔管率高和呼吸、发音、吞咽功能恢复好等优点,值得同道借鉴。Objective: To explore the applied value of sternohyoid muscle and cricohyoidoepiglottopexy(CHEP) for reconstruction of larynx function after vertical partial laryngectomy(VPL). Methods: The function of the larynx was reconstructed after VPL by using sternohyoid muscle and CHEP performed on randomized 122 cases of glottic laryngocarcinoma of stage T2 N0 M0 from January 2011 to December 2013. Meanwhile, unilateral or bilateral selective neck dissections were operated, and the function of the larynx was evaluated separately at 1 week and 3 months after operation. Results: Swallowing function:109(109/122,89.3%) cases were assessed with the "I" degree because of a smooth swallow without choking or coughing;7(7/122,5.7%) cases were assessed with the "II" degree for swallowing liquid food with choking or coughing;and the last 6(6/122,5%) patients who choked and coughed obviously with dry and liquid food were in the "III" degree. Decannulation rate: all cases were decannulated successfully without laryngostenosis, and the decannulation rate was 100%.Respiratory function: 12(12/122,9.8%) cases were confirmed to the "I" degree, 77(77/122,63.1%) cases were assessed with the "II" degree, and the last 33(33/122,27.1%) cases were assessed with the "III" degree. Voice function: 96(96/122,78.6%) patients spoke hoarsely(degree II), and 26(26/122,21.4%) patients talked with obviously hoarse voice(degree III). The 3-year and 5-year survival rates for all patients were about 93.3% and 89.8% respectively, and there was no statistically significant difference between the 3-year survival rate and the 5-year survival rate(χ^2=0.411,P>0.05). Conclusion: The application of sternohyoid muscle and CHEP in the reconstruction of larynx function after VPL has many advantages, such as high decannulation rate and satisfactory respiratory, voice and swallowing functions, which deserves to be recommended.

关 键 词：胸骨舌骨肌 带状肌 喉垂直部分切除术 部分喉切除术 喉功能 喉癌 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]