喉近全切除喉功能重建术

Laryngeal reconstruction after near total laryngectomy

目的为了减少喉全切除率并重建喉功能。方法自１９９１～１９９６年作喉近全切除喉功能重建术１９例。男８例，女１１例。年龄最大７４岁，最小４０岁，平均５７．６岁。临床分期Ⅱ期２例，Ⅲ期９例，Ⅳ期８例。手术特点是：切除舌骨，保留环状软骨及一侧杓状软骨，将环状软骨前缘与舌根切缘吻合，增强了舌根对新喉口的遮盖作用，减轻了误咽。结果全部病例术后发音功能良好，多数病例误咽不重。５例拔除套管经喉呼吸。１４例新喉腔狭窄经气管造口呼吸，其中１０例气管外孔宽阔不带套管，４例仍带套管。３年生存率７８．６％（１１／１４），５年生存率７５％（３／４）。结论该术式在保存喉功能减少喉全切除率方面有一定作用。

Objective To reduce the rate of near total laryngectomy and reconstruct laryngeal function. Method A retrospective review was made on 19 patients treated by near total laryngectomy and laryngeal reconstruction from 1991 to 1996. Eight patients were male and 11 were female. The age range was from 40 to 74 years, with a mean age of 57.6. Two cases were in stage Ⅱ,9 cases stage Ⅲ,8 cases stage Ⅳ.The characteristic of this operation is to remove hyoid bone and reduce aspiration. Results Speech function in all patients was good. Deglutition in most patients was good. Five patients breathed through the larynx after decannulation. Fourteen patients respired through tracheostoma because of stenosis of laryngeal cavity. Among them, 10 cases did not need cannula for their wide tracheostomas, 4 cases needed cannula. Three year survival rate was 78.6%(11/14), 5 year survival rate was 75%(3/4). Conclusion Laryngeal reconstruction near total laryngectomy is helpful to restore laryngeal function and decrease the rate of total laryngectomy.