胸骨舌骨肌组织瓣在保留喉功能的梨状窝内侧壁癌切除术中的应用  

Application of the sternohyoid muscle flap in the medial wall pyiform sinus cancer surgery with the preservation of laryngeal function

作　　者：许莉[1] 施涛 黄媛媛[1] 季俊峰[1] 吴明海[1] 陈伟[1] 张勇[1] 王志颐 江满杰[1] XU Li;SHI Tao;HUANG Yuan-yuan;JI Jun-feng;WU Ming-hai;CHEN Wei;ZHANG Yong;WANG Zhi-yi;JIANG Man-jie(Department of Otolaryngology,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)

机构地区：[1]东部战区总医院(原南京军区南京总医院)耳鼻咽喉头颈外科,南京210002

出　　处：《医学研究生学报》2021年第11期1177-1181,共5页Journal of Medical Postgraduates

基　　金：江苏省博士后基金(2019K085);江苏省青年医学重点人才项目(QNRC2016917)。

摘　　要：目的咽喉部肿瘤切除术后选择合适的修复方法是影响患者术后恢复的重要因素。文中旨在探讨胸骨舌骨肌组织瓣在保留喉功能的梨状窝内侧壁癌患者手术中的应用。方法回顾性分析2014年12月到2021年1月东部战区总医院耳鼻咽喉头颈外科术中利用胸骨舌骨肌组织瓣进行喉功能重建的22例梨状窝内侧壁癌患者临床资料。术前先评估声门旁间隙的侵犯情况,6例(27.27%)声门旁间隙无明显受累者术中制作胸骨舌骨肌肌筋膜瓣,行梨状窝内侧壁切除+胸骨舌骨肌筋膜修补咽腔缺损;9(40.9%)例声门旁间隙部分受累者制作胸骨舌骨肌舌骨组织瓣,术中行梨状窝内侧壁切除+患侧水平半喉切除+胸骨舌骨肌舌骨组织瓣重建喉功能;7(31.81%)例声门旁间隙消失者术中制作胸骨舌骨肌舌骨组织瓣并行患侧梨状窝内侧壁切除+患侧垂直半喉切除+胸骨舌骨肌-舌骨组织瓣喉功能重建。评估其临床治疗效果。结果所有患者手术切口均I期愈合,无咽瘘及喉狭窄发生;术后恢复吞咽功能平均(16.0±4.5)d。术后6个月内顺利拔管21(95.4%)例。1例患者发生吸入性肺炎经治疗后于12个月拔管,最终拔管率达到100%。结论梨状窝内侧壁癌患者术前重点评估声门旁间隙侵犯程度,选择胸骨舌骨肌组织瓣进行喉功能重建,手术创伤小、恢复好,并发症少,值得临床推荐。Objective The selection of appropriate repair method after laryngopharyngeal tumor resection is an important fac-tor afcting the postoperative recovery of patients.This paper aims to explore the efctve application of the stemnohyoid muscle flap in the medial wall pyriform sinus cancer surgery with the preservation of laryngeal function.Methods A retrospective study of 22 cases with media wall of pyriform sinus cancer surgery with the preservation of laryngeal funetion with the application of sternohyoid muscle tissue flap in Eastern Theater Command General Hospital from December 2014 to January 2021 was carried out.The invasion of the parachilar space was evaluated before surgery.In 6 cases(27.27%)with media wall of pyriform sinus without obv ious involvement of the parachilar space,myofascial flap of the sternohyoid muscle was made during surgery,and the resection of the media wall of pyriform sinus+sternohyoid muscle fascia were performed to repair the pharyn-geal cavity defect.In 9 cases(40.9%)with media wall of pyriform si-nus with part involvement of the parachilar space,sternohyoid muscle-hyoid tissue flap was made during surgery,and the resection of the media wall of pyriform sinus+horizontal hemilaryngectomy on the af-fected side+stermohyoid muscle-hyoid tssue flap were performed to re-construct the laryngeal function.In 7 cases(31.81%)with the disappearance of the involvement of the parachilar space,sternohyoid muscle-hyoid tissue flap was made during surgery,and also the resee-tion of the media wall of pyriform sinus on the afected side+vertical hemilaryngectomy on the afected side+stermohyoid muscle-hyoid tissue flap were performed to reconstruct the laryngeal function.Then the clinical therapeutie efcts were evaluated.Results All surgical incisions healed at stage I,and no pharyngeal fistula or laryngeal stenosis occurred,and the average recovery of swallowing function was(16.0±4.5)days.Successful extubation ocured in 21 cases(95.4%)within 6 months after operation.One patient devel-oped aspiration pn

关 键 词：下咽肿瘤 喉功能 外科皮瓣 外科手术 胸骨舌骨肌瓣 

分 类 号：R739.63[医药卫生—肿瘤]