喉环上部分切除喉腔成形术

The reconstruction of laryngeal function in subtotal laryngectomy by pedicled flaps

目的 探讨提高中晚期喉癌生存率 ,避免或减轻术后呛咳程度 ,提高发音质量的方法。方法 40例中晚期喉癌采用次全喉切除术 ,保留一侧或两侧杓状软骨 ,用带蒂甲状软骨膜或肌膜 ,于一侧杓状软骨和环状软骨或第一气管环 5点或 7点处之间缝合重建声带 ,并将切除的杓状软骨处加高成形再建杓区。环舌固定。结果 3年、5年生存率分别为 85 .0 % (34/ 40 )和 76 .2 % (16 / 2 1)。吞咽无呛咳 36例 (90 .0 % ) ,轻度呛咳 4例 ;发音良好 37例 (92 .5 % ) ;拔管率为 92 .5 % (37例 )。结论 喉次全切除带蒂软骨膜环杓连接喉功能重建术 ,在不影响生存率和拔管率的同时 ,有效防止了误吸 。

Objective To explore the possibility of subtotal laryngectomy in the treatment of advanced laryngeal cancer and selection of reconstruction. Methods Forty patients were treated surgically by subtotal laryngectomy with preservation of arytenoid cartilage and perichondrium. The pedicled flaps between cricoid cartilage and arytenoid cartilage were sewed up. The new larynx was reconstructed by suturing the cricoid or trachea to the hyoid bone or the tongue base. Results The 3 and 5 year survival rates were 85.0% and 76.2% respectively. Decannulation rate was 92.5%. Conclusion The reconstruction of laryngeal function in subtotal laryngectomy by pedicled flaps not only is safe and beneficial to the patients with the cancers above the cricoid, but also improves the quality of patient′s life.