改良喉额侧部分切除喉功能重建术的实验研究

The Experimental Study of Modified Frontolateral Partial Laryngectomy without Tracheotomy

目的建立改良喉额侧部分切除喉功能重建术动物模型,验证其可行性。方法解剖离体组6只实验犬的喉体,对其原始声门面积、喉额侧部分切除后缝合甲状软骨切缘后的声门面积及在双侧切缘中间嵌入软骨条后(改良术式)的声门面积进行测量,比较各组数据之间的差异。在体组对10只实验犬分别行喉裂开右侧声带切除术、改良喉额侧部分切除喉功能重建术,测量并比较各组术后声门面积,10组(每组3名)志愿者对术后犬吠声进行评估。结果离体组:喉额侧部分切除后的声门面积19.48±7.89mm2,较原始声门面积(39.71±13.71mm2)明显缩小(t=5.74,P<0.05);改良喉额侧部分切除后的声门面积为49.90±12.25mm2,与原始声门面积比较差异无统计学意义(t=2.47,P>0.05)。在体组:喉裂开右侧声带切除术后声门面积与术前比较差异无统计学意义(Q=0.047,P>0.05);改良喉额侧部分切除喉功能重建术后声门面积与术前比较差异无统计学意义(Q=8.74,P>0.05),与喉裂开右侧声带切除术后声门面积比较差异无统计学意义(Q=8.78,P>0.05);术后实验动物叫声仍可分辨。结论改良喉额侧部分切除喉功能重建术可有效保持喉腔正常大小,可用于喉狭窄等喉功能不良的整复。

Objective To build an animal model in order to investigate and to highlight new developments in the treatment of early true vocal cord cancer with modified frontolateral partial laryngectomy without traeheostomy. Methods The larynges of 6 eanines were excised. The data of all 6 canines were compared to establish the theoreti cal model to confirm the feasibility of modified frontolateral partial larnygectomy without tracheotomy. Also the data of all 10 canines were compaired to confirm the feasibility of modified frontolateral partial laryngectomy without tracheotomy in vivo. The voice of all 10 canines were studied after operations. Results For the Ex vivo group, the areas of 6 canine~ excised larynxes in the initial state and after modified frontolateral partial laryngectomy without tracheotomy but with the closed cartilage showed significant deviation（t= 5.74 P〈0.05）. The areas of 6 canines excised larynx in initial state and after modified frontolateral partial laryngectomy without tracheotomy and with the cartilage open showed no significant deviation（t=2.47 P〉0.05）. In the vivo group, the areas of 10 canines larynges in initial stale and after right chordectomy with laryngofission showed significant deviation（Q= 0. 047 P〉0. 05）. The areas of 10 canlne larynx in the initial state and after modified frontolateral partial laryngectomy without tracheotomy showed no significant deviation（Q=8.74 P）〉07. 05）. The voice of all the 10 canines after operations can be recognized by 10 groups of volunteers. Oonclusiorl Modified frontolateral partial laryngectomy without tracheostomy is an expedi tious and highly successful means of eradicating early and selected invasive glottic squamous cell carcinomas.