带蒂的颈阔肌皮瓣行喉成形术后喉内形态及组织病理学变化研究

Morphological and Histopathological Changes in Platysma Myocutaneous Flap after Laryngoplasty

目的 研究行喉部分切除颈阔肌皮瓣修复喉腔的声门型喉癌患者出院后恢复情况和移植肌皮瓣的变化情况.方法 患者出院后不同时间（术后1个月~20年以上）通过门诊检查,了解患者症状（声嘶、呛咳等）改善情况;电子喉镜检查喉内皮瓣的形态结构变化,并喉腔内皮瓣活检行HE染色,常规光镜下观察其组织病理变化.结果 患者出院后颈部切口均愈合,瘢痕不明显;均无明显呛咳,声嘶症状逐渐改善.电子喉镜检查显示术后6个月喉腔内肌皮瓣无肿胀,与黏膜缝合处愈合,无肉芽生长.假声带形态良好,发声闭合可,肌皮瓣逐渐呈黏膜样改变.病理检查也发现肌皮瓣趋向黏膜变化,其在喉腔内上皮角化较正常减少,皮肤附件有退化,毛囊减少,细胞未见明显异型性变化,间质有炎性细胞浸润.结论 带蒂的颈阔肌皮瓣行喉成形术是安全有效的手术方式.

Objective To study the recovery of patients with glottic laryngeal carcinoma and the changes in transplanted platysma myocutaneous flap after laryngeal reconstruction following partial laryngeetomy. Methods Patients discharged from hospital （1 month-more than 20 years after operation） were examined in our outpatient department to understand the improvement in symptoms （hoarseness,cough, etc. ）. The morphological changes in laryngeal flap were observed using electronic laryngoscopy. In addition, HE staining was performed after flap biopsy to observe the pathological changes under light microscope. Results Neck incision healed and hoarseness gradually improved without obvious scar and cough in all patients. Electronic laryngoscopy revealed that the seam of flap and mucosa healed and the flap had no swelling and granuloma growth 6 months after operation. The false vocal cords showed good shape and the closure of vocal folds were fine. The myocutaneous flap showed mucosal changes gradually. Pathological examination revealed that the flap showed mucosal changes with reduced keratinocytes,degraded skin appendages,decreased hair follicles and inflammatory cell infiltration. No obvious changes were found in cell atypia. Conclusion The pedicle platysma flap laryngoplasty is a safe and effective surgical approach.