早期声门型喉癌“抽屉式”切除后钛板辅助下喉功能重建术的疗效分析

Therapeutic Effect of the “Draw-Out Resection” and Reconstruction of Laryngeal Function with Titanium Plate in Treatment for Early Glottic Laryngeal Carcinoma

目的探讨早期声门型喉癌治疗的新式手术方法的疗效。方法收集行新术式的早期声门型喉癌患者12例,其中T_(is) N_0M_01例,T_(1a)N_0M_0 6例,T_(1b)N_0M_0 1例,T_2N_0M_0 4例。常规显露声门区肿瘤的范围,沿肿瘤外约0.5 cm连同患侧相应的甲状软骨板"抽屉式"切除肿瘤,残余的喉部黏膜对位缝合、重建声带、颅颌面钛板内固定以重建喉功能,分析患者术后拔管率、发音功能、误咽情况。结果 12例患者均得到随访,随访时间15.5月(6～30)月,至今未发现术后复发病例,目前生存率100%。术后拔管时间为12.2 d(8～15 d)。50%的患者对自己的发音满意,误咽的发生率为8.3%。结论新术式对早期声门型喉癌具有切除彻底、修复良好、操作简便、疗效好的优点。

Objective Objective To analyze a new surgical method for the early glottis laryngeal carcinoma in our department and to evaluate its therapeutic effect and prognosis.Methods 12 patients underwent the new surgical method including one case of TisN0M 0,six cases of T1aN0M0,one case of T1bN0M0,and four cases of T2N0M0.Conventional tracheostomy,exposing the scope of the glottis tumor,was performed to resect the mass along the cancer with 0.5 cm margins,including along with the ipsilateral thyroid cartilage plate by"draw-out resection"method.The following were performed:the remaining laryngeal mucosa suture for reconstruction of the vocal cords.We resected the thyroid cartilage plate with titanium plate internal fixation of cranial and maxillofacial while restored laryngeal function.We then analyzed postoperative time of extubation,pronunciation,and incidence of ingestion.Results The 12 patients were followed up for an average of 15.5(6~30)months.There were no postoperative recurrence patients and the current survival rate was 100%.The postoperative time of extubation was 8~15 d,and the average time was 12.2 d.Fifty percent of the patients were satisfied with their own pronunciation,and the incidence of ingestion was 8.3%.Conclusion This method has advantages of complete resection and being simple.It can provide agood restoration of laryngeal functions and good curative effect for early glottic laryngeal carcinoma.