垂直半喉切除黏骨膜瓣喉重建术对发声功能的影响(英文)

Laryngeal reconstruction with mucoperiosteum valve following vertical partial laryngectomy for vocal function

背景:喉部分切除后的功能重建,传统方法多使用胸骨舌骨肌瓣等作修复材料,但远期效果不理想。目的:探讨用甲状软骨外层黏骨膜瓣修复创面并重建发声功能的效果。设计:以患者为研究对象,前后对照观察性研究。单位:一所市级医院耳鼻咽喉科。对象:选择1998-06/2004-05汕头市第二人民医院耳鼻咽喉科收治喉癌患者57例,男56例,女1例;年龄37～78岁,平均60.38岁;病程2个月～1年,平均约5个月。方法:对57例喉癌患者,保留患侧甲状软骨外层黏骨膜瓣,向内翻入至喉腔,以覆盖创面,并重建声带。主要观察指标:终点结局指标:治疗前后症状和功能变化及卡氏评分。危险性指标:不良事件和副反应。结果:57例手术均取得成功,治疗前呼吸道梗阻、声音嘶哑发生率分别为38.9%和98.1%,治疗后分别为1.9%和96.3%,卡氏评分治疗前、后分别为40和70分。未出现近、远期喉狭窄等并发症。结论:垂直半喉切除黏骨膜瓣喉重建术操作较容易,创面覆盖好,发声效果满意,对呼吸功能无影响,并发症发生率低,远期效果理想。

BACKGROUND:Although the sternohyoid muscular valves are traditionally used as reparative material for functional reconstruction after partial laryngectomy,the late term results are not so satisfactory.OBJECTIVE:To investigate the efficacy of using external layer mucoperiosteum valve of thyroid cartilage to repair the wound surface and reconstruct vocal function. DESIGN:A self controlled observational trial using the patients as subjects.SETTING:Department of otolaryngology of a municipal hospital.PARTICIPANTS:A total of 57 patients with laryngocarcinoma were selected from the Department of Otolaryngology,Shantou Second People's Hospital,from June 1998 to May 2004.Among them,there were 56 men and 1 woman who were aged 37 to 78 years with the average age of 60.38 years and whose disease duration was two months to one year with the average of five months.METHODS:In the 57 patients with laryngocarcinoma,their external layer mucoperiosteum valves of thyroid cartilages in the affected side were preserved and inverted into laryngeal cavities,which were used to cover the wound surface and rebuild the vocal fold.MAIN OUTCOME MEASURES:The final outcome indices: changes in the symtoms and function and Karnofsky scores before and after treatment.Risk indices:adverse events and side effects.RESULTS:The operations on the 57 patients were successful.The incidence of respiratory tract obstruction and hoarseness in the patients before operation was 38.9% and 98.1% ,but 1.9% and 96.3% after treatment.Karnofsky score was 40 and 70 before and after treatment, respectively.No complications of pharyngeal stricture occurred in the near and long term.CONCLUSION:Vertical partial laryngectomy and laryngeal reconstruction with mucoperiosteum valve are easy to operate.The recovery of the wound surface is good,phonation efficacy is satisfacory, and respiratory function is not affected.The treatment has low incidence of complications and satisfactory long term results.