保留部分甲状软骨的垂直部分喉切除术

Vertical Partial Laryngectomy with Reserving Partial Thyroid Cartilage

目的 探讨垂直部分喉切除术中保留患侧部分甲状软骨板的临床应用。方法 对 18例声门型喉癌 (T2 13例、T35例 )行垂直部分喉切除术时采用保留患侧甲状软骨板上缘 0 .3cm和后缘 1/5软骨 ,使保留的软骨形成“┌”或“┐”型支架并应用颈深筋膜瓣整复喉缺损的方法进行治疗。结果 18例拔胃管后即恢复吞咽功能 ,仅最初几天进流食时呛咳。术后 2～ 3月拔管 ,均恢复喉发音和呼吸功能 ,拔管率 10 0 % ,随访 1～ 3年 ,复发 1例 ,颈淋巴结转移 1例。结论 保留患侧部分甲状软骨板并应用颈深筋膜瓣整复喉缺损对T2 、部分T3 声门型喉癌的治疗在根治肿瘤、保留喉功能 ,避免喉狭窄、拔管困难和误吸等并发症是有效的 。

Objective To descuss the clinical application of the reserving partial affected region lamina cartilaginis thyroideas in vertical partial laryngectomy. Methods 18 cases of glottal laryngocarcinoma (13 cases of T 2, 5 cases of T 3) were treated with vertical partial laryngectomy, in which the superior border (0.3 cm) and 1/5 poterior border of the affected part lamina cartilaginis thyroideas were reserved. The reserved cartilage were formed '┌' or '┐' type bracket, meanwhile, the deep cervical fascia valve was used for repairing larynx defect. Results 18 cases recovered swallowing function soon after their stomach tube were extracted, and only occurred cough when they took liquid diet in initial days. 2～3 months after the operation the tracheal tubes were extracted. The patients' vocalization and respiratory functions were all recovered. The rates of extracting tubes were 100%. Follow up survey was 1～3 years, 1 case relapsed, 1 case occured lymphonodi cervecales metastasis. Conclusion Reserving partial affected region lamina cartilaginis thyroideas and repairing larynx defect with the deep cervecal fascia valve to treat the patients of glottal laryngocarcinoma (T 2 and partial T 3) were effect in curing tumor, reserving larynx function, preventing the complication of larynx stricture and extracting tube dificultly and miss inspiratory.