喉部分切除术后喉功能重建

Reconstruction of the laryngeal function after partial laryngectomy

目的探讨喉部分切除术后喉功能重建的方法。方法对我院自1990年6月～2000年6月的65例T3及T4喉癌患者,采用一种或多种方法复合重建喉功能,包括重建声门关闭功能;重建会厌覆盖功能;保留或重建梨状窝;保护喉上神经和喉返神经;保持宽大的喉咽部;切断环咽肌。结果65例中61例获得随访,术后均能发音,术后2～4周拔除鼻饲管,无误吸及呛咳。喉声门型癌和喉声门上型癌术后拔管率分别为45.8%(11/24)和87.8%(36/41),3年和5年生存率分别为83.3%(20/24)、68.3%(28/41)和78.3%(18/23)、54.1%(20/37)。结论在彻底切除病变的基础上,采用多种方法,保全喉功能,对提高患者的治疗效果和生存质量均十分重要。

OBJECTIVE To discuss the methods ofreconstruction of the laryngeal function after partial laryngectomy. METHODS Sixty-five patients with ad-vanced laryngeal carcinoma underwent partial laryngec-tomy from June 1990 to June 2000 in our hospital. Thefunction of larynx were restored by methods as follows:①reconstruct the glottic closure function.② reconstructthe covering function of the epiglottis. ③ resect hyoidbone.④ preserve or reconstruct the pyriform sinus.⑤protect superior laryngeal nerve and recurrent laryngealnerve.⑥ make the hypopharynx wide.⑦ cut off thecricopharyngeal muscle. RESULTS All the patients re-stored the speaking function, and they were extractedthe nasal feeding tube at 2 to 4 weeks after operation,meanwhile no aspiration and choking accident occurred.The decannulation rates of the patients with glottic car-cinoma and supraglottic carcinoma were 45.8 %( 11/24)and 87.8 % (36/41)respectively.The 3- and 5-year sur-vival rates of the glottic carcinoma and supraglottic car-cinoma patients were 83.3 %(20/24),68.3%(28/41)and78.3 %(18/23),54.1 %(20/37)respectively. CONCLUSIONThe reconstruction of the laryngeal function after laryn-gectomy had important significance for improvement ofthe quality of life of the patients with laryngeal carcinoma.