声门上水平喉部分切除术中舌骨去留对误咽的影响

Preservation or resection of the hyoid bone on aspiration after supraglottic horizontal partial laryngectomy

目的探讨声门上水平喉部分切除术中保留与切除舌骨对误咽的影响。方法回顾分析1998年1月至2011年10月菏泽市立医院耳鼻咽喉科收治的39例声门上型喉癌行声门上水平喉部分切除术的临床资料,将其中年龄在56~67岁且无脑血管病、神经系统疾病及呼吸系统疾病的声门上型喉癌（T1~T3）行声门上水平喉部分切除术的39例患者作为观察对象,其中19例未切除舌骨,20例切除舌骨。结果病例切缘均为阴性,发声接近正常,拔管率为100%;保留舌骨的19例中,2例（10.5%）有轻度误咽,10例（52.6%）中度误咽,7例（36.8%）重度误咽,误咽恢复时间为（31±3）d;2例并发吸入性肺炎。切除舌骨的20例中,轻度误咽11例（55.0%）,中度误咽9例（45.0%）,无重度误咽,误咽恢复时间为（15±2）d;无吸入性肺炎发生。结论声门上水平喉部分切除术中切除舌骨、充分利用舌根对声门的遮盖作用,可有效减轻术后误咽程度,缩短误咽恢复时间,防止或减少吸入性肺炎的发生。

Objective To investigate the effect of preservation or resection of the hyoid bone on aspiration after supraglottic horizontal partial laryngectomy. Methods A total of 39 patients（ 56 to 67 years old） with supraglottic laryngeal carcinoma（ T1-T3） without cerebrovascular diseases,nervous system diseases and respiratory diseases were chosen as the observation objects,and of them,19 patients were preserved the hyoid bone and 20 were removed the hyoid bone.Results The incision margin of all cases was negative. The phonation approached normal and the decannulation rate was 100%. Of the patients preserving the hyoid bone,2 had mild aspiration（ 10. 5%）,7 serious（ 36. 8%） and 10moderate（ 52. 6%）,and the restoration duration was（ 31 ± 3） days. Of the patients removing the hyoid bone,11 had mild aspiration（ 55. 0%）,9 moderate（ 45. 0%） and none serious,and the restoration duration was（ 15 ± 2） days without aspirated pneumonia. Conclusion Removing the hyoid bone with supraglottic horizontal partial laryngectomy can make good use of the function of the tongue root to shelter glottis,which is an effective way to relieve the post-operation aspiration,shorten the restoration time and prevent or decrease the aspirated pneumonia.