水平垂直喉部分切除创面修复临床观察

Investigation on repair methods of larynx following partial laryngectomy

本文报道自 1979年 12月～ 1994年 7月 ,50例水平垂直喉部分切除创面修复结果。 1甲状软骨膜修复 11例 ;2甲状软骨膜及其附丽肌肉修复 30例 ;3骨肌瓣修复 9例。结果 :三种修复方法发音清晰响亮者分别为 4例 (36 .4 % ) ,2 2例 (73.3% )和 8例 (88.9% )。全组发音清晰响亮者计 34例(6 8.0 % ) ,略低哑 13例 (2 6 .0 % ) ,低哑 3例 (6 .0 % )。平均恢复正常经口进食时间分别为 17.2、13.1和10 .2天。拔管率分别为 81.8% (9/ 11)、80 .0 % (2 4 / 30 )和 77.8% (7/ 9)。认为骨肌瓣是修复水平垂直喉部分切除创面的最佳选择。

From December 1979 to July 1994,fifty patients with laryngeal carcinoma were treated by surgery in our department.There were 29 males and 21 females,ranging in age from 35 to 64 years old.Among 50 patients,47 were laryngeal squamous cell carcinoma (37 in supglottis,stage T 2N 0 4,T 2N 1 1,T 3N 0 21,T 3N 1 8,T 3N 2 1,T 4N 1 2;6 in glottis,stage T 3N 0 6;and 4 in X,stage T 3N 0 1,T 3N 1 3),2 in laryngeal malignant papilloma and 1 in laryngeal smooth muscle sarcoma.The surgical approach was horizontal and vertical partial laryngeactomy.The defects were repaired by fascia in 11,thyroid fascia and its attached muscles in 30 cases,osteomuscular flap (hyoid bone and its atached strap muscles) in 9 cases.Results showed as following:The rates that patients enjioyed a socially acceptable voice were 36.4% (4/11),73.3% (22/30),88.9% (8/9) for the above three groups respectively.In our series,the voice was clear and loud in 34 cases (34/50,68.0%),lower mute in 13 cases (13/50,26.0%) and low mute in 3 cases (3/50,6.0%).The average time to resume normal mouth food taking were 17.2 days,13.1 days and 10.2 days respectively.The decannulation rates were 81.8% (9/11),80.0% (24/30) and 77.8% (7/9) respectively.We think that using of the osteomuscular flap are best materials to repair the defect following horizontal and vertical partial laryngectomy.