会厌舌瓣在喉癌声门上缺损修复术中的应用  

Application of epiglottic tongue flap in supraglottic defect repair of laryngeal cancer

作　　者：曲翔宇 朱晗 柳忠禄[1] 牟亚魁 郭文涛 张华[1] QU Xiangyu;ZHU Han;LIU Zhonglu;MU Yakui;GUO Wentao;ZHANG Hua(Department of Otorhinolaryngology&Head and Neck Surgery,Yantai Yuhuangding Hospital,Qingdao University/Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases/Yantai Key Laboratory of Otorhinolaryngologic Diseases,Yantai 264000,Shandong,China;Department of the 2nd Medical College of Binzhou Medical University,Yantai 264000,Shandong,China)

机构地区：[1]青岛大学附属烟台毓璜顶医院耳鼻咽喉头颈外科/山东省耳鼻喉疾病临床医学研究中心/烟台市耳鼻喉疾病重点实验室,山东烟台264000 [2]滨州医学院第二临床医学院,山东烟台264000

出　　处：《山东大学耳鼻喉眼学报》2025年第1期77-84,116,共9页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：山东省重点研发计划(竞争性创新平台2022CXPT023);山东省自然科学基金面上项目(ZR2021MH116);山东省自然科学基金项目(ZR2023QH460)。

摘　　要：目的总结应用会厌舌瓣联合颈前带状肌瓣修复喉癌声门上缺损的喉功能重建经验。方法回顾性分析烟台毓璜顶医院119例非全喉切除术的喉癌患者的临床资料,主要是喉癌声门上缺损较大的T2-T3患者,根据2017年AJCC分期标准,其中声门型喉癌61例(T2N0M023例,T2N1-2M012例,T3N0M022例,T3N1-2M04例),声门上喉癌58例(T2N0M025例,T2N1-3M020例,T3N0M03例,T3N1-3M010例)。其中男116例、女3例,年龄45~81岁。在保证安全切缘、彻底切除肿瘤前提下,选择喉水平部分切除、喉垂直部分切除术及扩大水平/垂直喉部分切除术等方式,采用会厌瓣、舌根组织瓣及联合颈前带状肌瓣修复喉部声门上缺损,统计术后发音及吞咽功能恢复、术后并发症、拔管率、生存率及转移复发等指标,评价应用会厌舌瓣等在喉癌声门上缺损喉功能重建中的优势。结果119例患者中,在拔管之后均可顺利恢复发音功能,总拔管率94.96%。鼻饲管分别于术后5~19 d内拔除。术后发生切口及套管口周围感染5例,喉瘘2例。全部病例随访36~70个月,3年生存率为82.35%。5年生存率为74.00%。所有患者复发14例(11.8%),远处转移11例(9.2%)。结论对于喉癌术中声门上缺损较大的患者,术前充分评估,制定个性化手术方案,应用会厌或舌根游离下拉形成的会厌瓣及舌瓣,或会厌舌瓣,必要时结合颈前带状肌瓣等可修复喉腔上部较大缺损,修复简便,减少了手术创伤,提高了术后拔管率及吞咽功能恢复,在喉癌喉功能重建中具有重要临床意义。Objective To summarize our experience of laryngeal function reconstruction using an epiglottic tongue flap combined with an anterior cervical muscle flap to repair supraglottic defects during laryngeal cancer surgery.Methods A retrospective analysis of 119 operations in patients hospitalized in the Yantai Yuhuangding Hospital who underwent laryngectomy for laryngeal cancer,mainly T2 and T3 lesions with postoperative defects on the glottis,according to the 2017 AJCC on Cancer staging criteria,including the glottis type in 61 cases(T2N0M023,T2N1-2M012,T3N0M022,T3N1-2M04)and 58 cases of supraglottic carcinoma(T2N0M025,T2N1-3M020,T3N0M03,T3N1-3M010).The study included 116 males and 3 females aged 45-81 years.Horizontal partial laryngectomy,vertical partial laryngectomy,and extended horizontal/vertical partial laryngectomy were performed to ensure safe margin and complete tumor resection.The epiglottis,tongue base tissue,and combined anterior cervical strap muscle flaps were used to repair the laryngeal supraglottic defects.To evaluate the advantages of the epiglottic tongue flap in the reconstruction of supraglottic defects after laryngeal cancer surgery,the postoperative recovery of voice and swallowing function,postoperative complications,extubation rate,survival rate,metastasis,and recurrence were recorded.Results Among the 119 patients,the phonation function was successfully recovered after extubation,and the total extubation rate was 94.96%.Nasogastric feeding tubes were removed within 5-19 days after the surgery.There were five cases of infection around the incision and cannula,and two cases of laryngeal fistula.All patients were followed up for 36 to 70 months.The 3-year and 5-year survival rates were 82.35%and 74.00%,respectively.Recurrence occurred in 14 patients(11.80%),and distant metastasis in 11 patients(9.20%).Conclusions Adequate preoperative evaluation and individualized surgical plans should be created for patients with large supraglottic defects during laryngeal cancer surgery.The epiglottis,tongue

关 键 词：喉癌 会厌瓣 舌瓣 颈前带状肌瓣 喉功能重建 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]