带蒂甲状软骨下移用于声门下喉癌环状软骨部分切除后的修复

Thyroid cartilage flap reconstruction of cricoid in the management of subglottic carcinoma

目的 探讨声门下喉癌部分喉手术治疗的方法及其疗效。方法 对 9例 1984年3月—1999年 3月手术治疗的声门下喉癌患者进行分析。按 1997年UICC修订案分期,Ⅱ期 (T2N0)2例,Ⅲ期(T3N0)2例,Ⅳ期 5例(T3N1 1例,T4N0 3例,T4N1 1例)。所有病例采用带蒂甲状软骨下移错位支架成形重建肿瘤切除后的软骨支架,分别应用甲状舌骨肌为蒂、胸骨甲状肌为蒂、咽下缩肌为蒂的甲状软骨下移。全部行颈清扫术。结果 9例患者全部保留了喉功能,发音良好。8例拔除气管套管, 1例未能拔管,拔管率 8 /9;全部患者恢复经口进食,无明显呛咳及吞咽困难。3年生存率8 /9, 5年生存率 6 /9。结论 对适合的声门下癌应用带蒂甲状软骨下移错位支架喉成形术,手术创伤小,一期形成软骨支架,带蒂软骨容易成活,提高了拔管率和喉功能的保留率,对声门下癌是一种可行的治疗方法。

Objective To evaluate the effect of conservative surgical management on patients with subglottic cancer. Methods Nine cases with subglottic carcinoma were treated surgically from 1984 to 1999. There were T2N0 lesions in 2 cases, T3N0-1 in 3 cases and T4N0-1 in 4 cases. All the cases underwent partial laryngectomy including partial cricoid resection. Variations of a pedicled thyroid cartilage flap were used for reconstruct the cricoid defect. The pedicle based muscule was thyrohyoid, sternothyroid or inferior constrictor. Unilateral neck dissection was performed on 7 cases and bilateral on two. Results The function of phonation were preserved in all cases. Eight of nine 8/9 were decannulated. Normal deglutition were achieved for all patients. The 3 and 5 year survival rates were 8/9 and 6/9, respectively. Conclusion(Pedicled )thyroid cartilage flap is appropriate for reconstruction of the cricoid defect in the conservative surgery of selected subglottic carcinoma.