复合舌骨瓣悬吊修复额侧部分喉缺损的临床研究

Laryngeal reconstruction by complex hyoid bone flap after frontal partial laryngectomy

目的报道用复合舌骨瓣悬吊修复额侧部分喉缺损，并且探讨术后喉功能和肿瘤预后情况。方法分析2008年9月至2012年8月中山大学肿瘤防治中心头颈科运用该技术治疗6例患者的临床资料。结果患者均在术后24h内进行鼻饲营养，进食糊状物、喝水和拔出鼻饲营养管的中位数时间分别是2．6，5．5和6．3d。未发生误吸和吸人性肺炎等严重不良事件。发声效果还是令人满意的。呼吸功能良好，无喉狭窄发生。第2例患者术后8个月声门旁间隙复发因而进行了喉全切除，其余病例均无瘤生存至今。中位生存时间是29．5个月（14—47个月）。结论复合舌骨瓣悬吊术可以一期修复额侧喉软骨和喉黏膜缺损，可以重建喉的吞咽、呼吸和发音功能。

Objective To describe a new flap technique, the combined hyoid bone and thyrohyoid membrane flap, for laryngeal reconstruction after tumor resection, and to evaluate clinical outcome. Methods Six patients requiring frontal partial laryngectomy for cancer were enrolled between September 2008 and August 2012. Results Nasogastric feeding was given in the first 24 hours after surgery. The median times of swallowing batter, drinking water and removal of the nasogastric tubes were 2.6, 5.5 and 6. 3 days respectively. All patients had good respiratory function, no dyspnea or dysphagia postoperatively. Voice quality was satisfactory. There were no deaths. The median of survival time was 29.5 months, ranging from 14 to 47 months. Only one case subsequently underwent total laryngectomy due to disease recurrence in the paraglottic space, no evidence of tumor recurrence in other cases. Conclusions The combined muscle- pedicle hyoid bone and thyrohyoid membrane flap is a reliable for one-stage repair of laryngotracheal defects and voice quality, swallowing function and ventilation after the procedure were favorable.