应用舌骨肌瓣修复部分喉术后缺损

Theuseofhyoidosteomuscularflapinextendedpartiallaryngectomy

用部分喉切除的功能保全性手术治疗喉癌。１９７９年设计舌骨肌瓣，用于修复喉大部切除的缺损，以保证在根治肿瘤前提下，恢复三大喉功能。对于一侧杓状软骨已固定的患者，需要切除杓状软骨者，宜用小块骨质代替，同时用一部分肌肉掩盖半侧喉腔。手术时在舌骨上切断下颌舌骨肌，取舌骨体一小块，宽约５毫米，同时切一条舌骨下宽蒂带状肌，形成舌骨肌瓣，将这块组织瓣向喉腔折转９０度，将舌骨固定在杓状软骨缺损处，肌肉即复盖患侧喉腔，拉拢下咽粘膜覆盖舌骨。自１９７９～１９９０年，共治疗１０８例。声门上型６６例，３期及４期病例三年生存率各为７８．６％及６６．７％。声门型４２例，３期三年生存率为７９．３％。气管套管拔除率７５％～８５％。８０％患者恢复近乎正常发声。吞咽功能全部恢复。

Thesurgicaldefectafterconventionalpartiallaryngectomypracticalyneedsnospecialtechniquetorepair.Onconservationsurgeryforlate(T3andT4)casesalargepartofthelarynxistoberesectedsothatthemarginofsurgicalclearanceisampleand,atthesametime,anappropriatemethodofreconstructionismandatorytorestoretheessentialfunctionsofthelarynx.Forthispur-posewedevelopedatechniqueofosteomuscularflaptorepairthedefectleftbehindafterathree-fourthslaryngectomy(forsupraglotticcase)oranextendedverticalpartiallaryngectomy(forglotticcase).Inbothcasesthearytenoidcartilageorthecricoarytenoidjointwasresectedtoensurethesafe-tymarginofresection.Themylohyoidmusclewasseveredattheupperborderofthebodyofthehy-oidbone.Asmalpieceofthehyoidbone(about5mm)anditsatachedstrapmuscleswereused.Themusclesweremadea90degreebenttowardthelaryngealcavity.Thehyoidbonewasusedtosubstitutetheremovedarytenoidandthemusclestobridgeoverthelaryngeallumen.Thepostcricoidmucosawasadvancedtocoverthetransplantedhyoidbone.Thenthecutedgeofthethyroidcartilagewasliftedupandsuturedwiththebaseofthetonguetoclosethewound.108casesweretreatedwithinaperiodof12years(1979～1990).ThethreeyearsurvivalratesforstageⅢandstageⅣofsupraglottictype(66cases)were78.6%and66.7%respectively,andforstageⅢofglottictype(42cases),79.3%.Thedecannulationratewas75%～85%,and80%ofthepatientsenjoyedasocialyacceptablevoice.Alcasesresumednormalmouth-food-taking.