脱细胞异体真皮在声门型喉癌中预防喉狭窄的应用  

Application of acellular dermal matrix in prevention of laryngeal stenosis in glottic carcinoma

作　　者：朱鑫[1] 赵锐[1] 冯成敏 程瑶 张西 邓启成 刘海[1] ZHU Xin;ZHAO Rui;FENG Chengmin;CHENG Yao;ZHANG Xi;DENG Qicheng;LIU Hai(Department of Otolaryngology,Affiliated Hospital of North Sichuan Medical College,Nanchong,637000,China)

机构地区：[1]川北医学院附属医院耳鼻咽喉科,四川南充637000

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第4期321-324,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：川北医学院校级科研项目(No:CBY22-QDA07);川北医学院附属医院院级课题(No:2019JC030、2019JC008)。

摘　　要：目的:探讨脱细胞异体真皮在声门型喉癌术中预防喉狭窄的效果。方法:将2018年2月-2022年12月55例声门型喉癌(T2、T3型)患者按意愿分为实验组(28例)和对照组(27例),采用喉裂开切除肿瘤方式,实验组术后术腔置入脱细胞异体真皮缝合,对照组12例术腔采用上下缘拉拢缝合,15例术腔采用胸骨舌骨肌筋膜瓣修补。结果:实验组有1例术后出现喉狭窄,系喉腔黏膜肿胀所致,对症治疗后肿胀消退顺利拔管。对照组有7例术后出现喉狭窄,其中3例系喉腔肉芽增生所致,对症治疗后顺利拔管;2例术后拔管后放疗出现进行性呼吸困难,再次行气管切开,治疗后顺利拔管;2例系喉腔黏膜肿胀,对症治疗后1例顺利拔管,1例长期戴管。实验组喉狭窄率3.6%(1/28)低于对照组25.9%(7/27),实验组治疗效果明显优于对照组(χ^(2)=5.526,P=0.019)。结论:声门型喉癌术腔置入脱细胞异体真皮能减少喉狭窄的发生,对喉狭窄有满意的预防效果。Objective:To investigate the effect of acellular dermal matrix in preventing laryngeal stenosis in glottic carcinoma patients.Methods: Fifty-five patients with glottic carcinoma(T2,T3)from February 2018 to December 2022 were divided into experimental group(28 cases)and control group(27 cases)according to their wishes.Acellular dermal matrix was placed in the operation cavity in the experimental group after laryngofission,while control group 12 cases were sutured by pulling the upper and lower edges,15 cases were repaired with sternohyoid muscle fascia flap.Results: In the experimental group,1 case had laryngeal stenosis caused by laryngeal mucosa swelling after operation,and extubated successfully after symptomatic treatment.In the control group,7 cases had laryngeal stenosis after operation,of which 3 cases were caused by granulation tissue hyperplasia in laryngeal cavity,and extubated after symptomatic treatment.2 cases extubated after operation suffered from progressive dyspnea during radiotherapy,and underwent tracheotomy again,extubation successful after treatment.2 cases caused by laryngeal mucosa swelling,after symptomatic treatment,one case was successfully extubated,and one case had long-term intubation.The laryngeal stenosis rate of the experimental group was 3.6%(1/28),which was lower than control group 25.9%(7/27),and the therapeutic effect of the experimental group was significantly better than control group(x^(2)=5.526,P=0.019).Conclusion: Implanting acellular dermal matrix in the operation cavity of glottic carcinoma can reduce the occurrence of laryngeal stenosis and have satisfactory preventive effect on laryngeal stenosis.

关 键 词：喉狭窄 脱细胞异体真皮 声门型喉癌 

分 类 号：R739.63[医药卫生—肿瘤]