非气管切开下改良额侧位喉部分切除重建术

Modified frontolateral partial larnygectomy without tracheostomy for early laryngeal cancer of the true vocal cord

目的探讨非气管切开的改良额侧位喉部分切除重建术治疗声带癌的可行性,及其在临床实践中的指导意义。方法随访41例行非气管切开下改良额侧位喉部分切除重建术的声带癌患者,其中声门型喉癌T1a病变34例,限于单侧声带的T2病变5例,单侧声带较广泛的重度不典型增生疑有恶变者2例。39例喉内组织缺损采用室带扭转与筋膜联合修复,2例用颈部皮瓣修补,喉前方以翻起的筋膜修补,使新喉腔呈"□"型,截面积增大。结果41例患者切口均Ⅰ期愈合,7～15 d出院。9例术后有不同程度的皮下气肿,皆于出院前自行消退。随访最长6.5年,最短4个月,均健在。结论改良喉成型,扩大喉腔截面积而非气管切开,是一种创伤小,而且有效的方法,可应用到各种喉部分切除术,以提高拔管率。

Objective To investigate the feasibility of modified frontolateral partial laryngectomy without tracheostomy in the treatment for early laryngeal cancer or severe atypical hyperplasia of the true vocal cord. Methods A retrospective analysis of 41 patients treated in the past 6 years with modified frontolateral partial laryngectomy without tracheostomy was carried out. There were 39 early laryngeal cancers of the lateral vocal cord with 34 in T1a stage and 5 in T2, and the remain 2 patients had severe atypical hyperplasia of the lateral vocal cord. An ipsilateral false vocal cord flap was used in 39 patients and cervical skin flap in 2 to reconstruct the defect after resection of the true vocal cord. In order to get a large laryngeal cavity, a reverted sternohyoid fascia was used to cover the front area, which made the new laryngeal lumen become ladder-shaped. Results The incisions of all 41 patients healed up by first intention. The only postoperative complication was subcutaneous emphysema, which developed postoperatively in 9 patients, but subsided prior to discharge. The estimated 1-, 3- and 5-year survival rates were all 100%. No patients died during the postoperative period. Condusion Modified frontolateral partial laryngectomy without tracheostomy is effective with a high rate of success in eradicating early or selected invasive glottic squamous cell carcinoma or severe atypical hyperplasia of the true vocal cord.