喉癌垂直切除和喉功能重建三种术式的探讨

Inquire into the three types of vertical laryngectomy and laryngeal function reconstruction in laryngeal carcinoma

目的 :研究喉癌垂直切除及喉功能重建的术式。方法 :依据患者病变的范围 ,为 2 5例喉癌患者分别用 3种术式行喉垂直切除术。 ( 1)垂直侧前位喉大部切除术 ;( 2 )垂直前位喉大部切除术 ;( 3)垂直式喉次全切除术。喉重建取材为 ( 1)带蒂颈阔肌皮瓣或胸骨舌骨肌甲状软骨衣 ;( 2 )带蒂舌骨或会厌复合组织 ;( 3)利用健侧的披裂软骨与下咽粘膜再造喉发音管。结果 :术后 2 3例发音吞咽满意 ,3年生存率为 92 %。结论 :在彻底切除喉癌的同时应保存或重建喉功能 。

Objective:To study the methods of vertical laryngectomy and laryngeal function reconstruction.Method:According to the range of the lesions,25 cases of laryngeal carcinoma were treated with vertical laryngectomy of three types,as follows,(1)The large part of anterior lateral vertical laryngectomy;(2)The large part of anterior vertical laryngectomy;(3)The subtotal vertical laryngectomy.The voice fistulas were reconstructed with the following materials:(1)Platysmal flap with pedunculus or sternohyoideus and thyroid cartilage membrane;(2)Hyoid bone with pedunculus or epiglottidean complex tissues;(3)Arytenoepiglottic cartilage and hypopharyngeal mucosa.Result:23 cases had good phonation and swallowing after operation.The survival rate of 3 years was 92%(23/25) Conclusion:When the authors peoform complete laryngectomy,they should reserve or reconstruct the laryngeal function.When performing large partial laryngectomy,they should repair the surface of wound to renovate the defect and recover the function.