组织移植在喉部分切除术后修复与功能重建中的应用

Application of tissue transplantation in the repair and functional reconstruction after partial laryngectomy

学术背景:喉结构和功能的修复与重建是喉部分切除术中的关键,近年来各种修复材料和修复方法层出不穷。目的:综合分析组织移植在喉部分切除术后修复与功能重建中的应用现状,为喉部分切除术后选择应用喉功能修复材料及重建技术提供参考。检索策略:应用计算机检索PUBMED1997-01/2007-07有关喉部分切除术后功能重建的文章,检索词"laryngectomy,laryngeal carcinoma/cancer,reconstruction",限定文献语种为"English";同时检索本校图书馆中国期刊全文数据库2000-01/2007-07有关喉部分切除术后功能重建的文章,检索词"喉部分切除术,喉癌,修复/重建",限定文献语种为中文。共检索到相关文献160篇,其中英文文献69条,中文文献91篇,选择与喉部分切除术后修复或重建有关的文章。初步筛选后,英文文献再进一步查找全文,主要选择权威杂志发表的临床研究类文章,排除综述和重复文献。最后共纳入31篇文献进行综述。文献评价:31篇文献中英文16篇,中文15篇,所有文献均为临床研究类文章。资料综合:功能重建是喉部分切除术中的关键,术后残喉结构修复技术迅速发展,以肌筋膜、带状肌瓣、颈前皮瓣、会厌等自体组织材料修复喉癌术后残喉应用广泛,功能良好;组织工程材料和其他异体材料在喉部分切除术后的应用目前也正在研究。结论:随着部分喉切除术的快速发展,各类修复材料及技术的应用日益成熟。残喉的修复没有固定的模式,行喉部分切除术时如何考虑肿瘤的类型、侵犯的程度、切除的范围等诸多因素,选取合适的修复材料及重建技术,恢复喉的发声、呼吸、吞咽保护功能,提高患者的生存率和生存质量,仍是一个值得探索的课题。

BACKGROUND： The repair and reconstruction of laryngeal structure and function play a crucial role in partial laryngectomy, and the repairing materials and methods have been developed rapidly in recent years. OBJECTIVE： To explore the present application of tissue transplantation on the repair and functional reconstruction after partial laryngectomy, and provide evidences for the selection of repairing materials and reconstructive techniques for laryngeal function. RETRIEVAL STRATEGY： A computer-based search of PubMed database was undertaken to identify the articles of functional reconstruction after partial laryngectomy published from January 1997 to July 2007, with the key words of ＂laryngectomy, laryngeal carcinoma/cancer, reconstruction＂ in English. Simultaneously, Chinese Journal Full-text Database was searched for the relevant articles published between January 2000 and July 2007 with the key words of ＂partial laryngectomy, laryngeal carcinoma, repair/reconstruction＂ in Chinese. Totally 160 relevant articles was retrieved, of which 69 articles were English and 91 articles Chinese. Articles on repair or reconstruction after partial laryngectomy were selected. After the primary filtration, fulltexts of the English articles were checked, and articles on review and with repetitive content were excluded. The articles on clinical research, which were issued in authorized journals, were selected. At last, totally 31 articles were included for review. LITERATURE EVALUTION： Among 31 included articles, 16 articles were English and 15 articles Chinese. DATA SYNTHESIS： Functional reconstruction is the key point in course of partial laryngectomy. Technique on repairing postoperative larynx have made a progress, and autologous tissues, such as myofascial flap, flap of strap muscles, myocutaneous flap of neck fascial lata and epiglottis, are extensively used for larynx, which have got good effect. The study of the application of tissue engineering and other variant materials after partial laryngectomy is going on. CONCLUSION： With rapid development of partial laryngectomy, all kinds of repairing materials and reconstruction techniques are used. Repairing postoperative larynx has no fixed mode. It is a very important topic to choose suitable repairing material and reconstruction technique according to different factors such as laryngeal carcinoma type, lesion degree and excision scope, so as to recover the vocalization, respiratory and deglutition function, and raise the patients＇ survival rate and life quality.