数字化技术联合3D打印技术重建甲状软骨在喉部分切除的应用  

Application of digital technique combined with 3D printing technique in reconstruction of thyroid cartilage in partial laryngectomy

作　　者：田皞[1,2] 喻建军[1,2] 周晓[1,2] 谌星[1,2] 左良[1,2] 高水超 蔡旭 宋波[3] 刘学奎[4] TIAN Hao;YU Jianjun;ZHOU Xiao;CHEN Xing;ZUO Liang;GAO Shuichao;CAI Xu;SONG Bo;LIU Xuekui(Depar tment of Second Head and Neck Surgery,Hunan Cacer Hospital,Changsha,Hunan,410013,China;Depar tment of Oncoplastic Surgery,Hunan Cacer Hospital,Changsha,Hunan,410013,China;Department of Radiology,Hunan Cacer Hospital,Changsha,Hunan,410013,China;Department of Head and Neck Surgery,Cancer Center of Sun Yat-sen University,Guangzhou,Guangdong,510060,China)

机构地区：[1]湖南省肿瘤医院头颈外二科,湖南长沙410013 [2]湖南省肿瘤医院肿瘤整形外科,湖南长沙410013 [3]湖南省肿瘤医院放诊科,湖南长沙410013 [4]中山大学肿瘤防治中心头颈外科,广东广州510060

出　　处：《中国耳鼻咽喉头颈外科》2020年第1期20-24,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：2018年度国家癌症中心攀登基金科研项目(NCC2018B60);2018湖南省自然科学基金项目(2018 JJ2244);2018长沙市科技局项目(kq1801101);2019湖南省卫生健康委项目(C2019078);湖南省肿瘤整形外科临床医学技术研究中心(2013TP4087);2018广州市科技计划项目(201803010043)。

摘　　要：目的在前连合受侵的声门型喉癌,甲状软骨需要部分切除的患者中,应用数字化联合3D打印技术辅助病灶的切除与残喉的修复重建。比较该术式与环舌骨会厌吻合术(cricohiodoepiglottopexy,CHEP)的优缺点,并评估其应用价值。方法2017年3月~2018年3月,笔者收治前连合受侵需行甲状软骨部分切除的喉癌患者12例,随机平均分配至A、B两组。A组患者利用数字化联合3D打印技术辅助病灶的切除、个性化钛网重建甲状软骨,喉内外采用临近肌瓣进行修复;B组患者接受改良CHEP。比较两组患者在术后住院时间、生活质量(发音状况、误咽程度、留置气管套管及胃管时间)、复发转移情况等差异。结果A组患者均按计划顺利实施手术,未留置胃管;3例行预防性气管切开,术后2周内拔除气管套管;所有病例于术后10天内出院,术后发音质量良好者多。B组中1例患者放弃治疗,其余5例全部接受手术;所有患者均行气管切开和留置胃管,2周~2个月拔除气管套管、胃管;术后2~3周出院,术后发声质量中等者多;其中1例因瘢痕增生导致喉腔狭窄于术后10个月再次气管切开。两组病例随访19~31个月,无复发转移;A组患者无1例钛网外露。结论前连合受侵的声门型喉癌,甲状软骨需要部分切除的患者,应用数字化联合3D打印技术辅助病灶的切除与残喉的重建,与CHEP术式相比,两者肿瘤学效果相近;但新的手术方法患者术后进食、发音功能较好;住院时间少、恢复周期短;生活质量明显提高,因此该术式值得推广应用。OBJECTIVE Digital technique combined with 3D printing technique was used to assist the resection of the lesion and repair the remnant larynx in glottic carcinoma patients with anterior commissure invaded and par tial resection of thyroid car tilage.The advantages and disadvantages of this method and cricohiodoepiglottopexy(CHEP)were compared,and its application value was evaluated.METHODS Twelve glottic carcinoma patients with anterior commissure invaded from March 2017 to March 2018 were randomly divided into group A or group B.Group A received surgery used digital technique combined with 3D printing technique to assist lesion resection,and reconstruct the thyroid cartilage with personalized titanium mesh.The internal and external of larynx were repaired with adjacent muscle flap.Group B received CHEP.The differences of postoperative hospital stay,quality of life(include the pronunciation,the degree of aspiration,the time of indwelling tracheal cannula and gastric tube),recurrence and metastasis were compared between the two groups.RESULTS All patients in group A were operated according to plan without indwelling gastric tube,3 patients underwent preventive tracheotomy and tracheal cannula was removed within 2 weeks after operation.All patients were discharged within 10 days after operation,and most of them had good pronunciation after operation.In group B,1 patient gave up treatment,and the other 5 patients underwent operation.All patients underwent tracheotomy and indwelling gastric tube,and the tracheal cannula and gastric tube were removed 2 weeks to 2 months after operation.Most of the patients were discharged from hospital 2-3 weeks after operation,and most of them had moderate pronunciation quality after operation.Among them,one case underwent tracheotomy 10 months after operation due to laryngeal stenosis for scar.The patients in the two groups were followed up for 19 to 31 months,there was no recurrence and metastasis,and there was no titanium mesh exposure in group A.CONCLUSION The new operation method

关 键 词：喉肿瘤 修复外科手术 数字化技术 3D打印技术 个性化钛网 

分 类 号：R739.65[医药卫生—肿瘤]