喉垂直前位切除带蒂胸骨舌骨肌瓣声带重建术的疗效分析

Effect of vertical anterior laryngectomy with pedicled sternohyoid flap for vocal cord reconstruction and glottal morphology

目的:探讨喉垂直前位切除带蒂胸骨舌骨肌瓣声带重建术的疗效。方法:对43例行喉垂直前位切除环会厌或环舌吻合术的喉癌患者临床资料进行回顾性分析,根据术中声带是否重建分为声带重建组(20例)与非重建组(23例),重建组采用带蒂胸骨舌骨肌瓣再造双侧声带,非重建组采用甲状软骨外膜修复创面。对2组患者术后呼吸功能、吞咽功能、发声功能及预后情况进行分析,通过电子喉镜检查及术后CT评估声带重建术后声门重建形态。结果:①2组患者随访期间均存活,重建组均未复发,非重建组有1例出现复发;重建组有2例声门区生长肉芽组织,1例出现喉瘘,非重建组有2例术后出现吸入性肺炎;②2组患者术后1年气管套管拔除率均为100%;重建组胃管拔除时间为(13.2±2.8)d,非重建组胃管拔除时间为(16.6±5.3)d,2组比较差异有统计学意义(P<0.05);重建组发声良好10例、中等6例、差4例,非重建组发声良好4例、中等14例、差5例,2组发声中等及以上者比较无差异(P>0.05),2组发声良好者比较差异有统计学意义(P<0.05);③重建组横径与正常检查者比较无差异(P>0.05);非重建组横径与正常检查者比较无差异(P>0.05),重建组与非重建组横径比较无差异(P>0.05);重建组前后径与正常检查者前后径比较差异有统计学意义(P<0.05),非重建组与正常检查者前后径比较差异有统计学意义(P<0.05),重建组与非重建组前后径比较无差异(P>0.05);重建组面积与正常检查者比较差异有统计学意义(P<0.05),非重建组面积与正常检查者比较差异有统计学意义(P<0.05),重建组与非重建组面积比较差异有统计学意义(P<0.05);④结合喉镜观察术后形态,2组患者杓区均呈现不同程度的肿胀,重建组声门区形态近似三角形,非重建组术后声门形态近似圆形。结论:喉垂直前位切除环会厌或环舌吻合带蒂胸骨舌骨肌瓣声带重建术术后气管套管拔管率高,吞咽、发声功能恢复好,能够提高患者生活质量,声门形态相对于非重建组更接近正常形态,值得临床推广。

Objective:To explore the effect of vocal cord reconstruction with sternohyoid muscle flap pedicled with vertical anterior laryngectomy.Method:The clinical data of 43cases of laryngeal carcinoma were analyzed retrospectively.According to whether the vocal cords were reconstructed,they were divided into vocal cord reconstruction group and non reconstruction group.Among them,20patients in the reconstruction group were reconstructed with pedicled sternohyoid muscle flap and 23patients in non-reconstruction group.In the non reconstruction group,the external membrane of thyroid cartilage was used to repair the wounds.Postoperative respiratory function,swallowing function,pronunciation function,postoperative prognosis,complications,and recurrence rate were compared between the two groups.Reconstruction of glottis after vocal cord reconstruction was evaluated by electronic laryngoscope and CT scan.Result:①Patients in both groups survived during the follow-up period.One patient in the non-reconstructed group had recurrence,and the reconstituted group had no relapse,3cases with complications occurred in the reconstruction group,including 2cases with granulation tissue in the glottic area,1case with laryngeal fistula,and 2cases with aspiration pneumonia were found in the non-reconstruction group.②1year postoperative tracheal cannula removal rate,gastric tube removal and pronunciation quality:the tracheal cannula removal rate was 100%in the two groups after surgery;the gastric tube removal time in the reconstruction group was(13.2±2.8)days,and(16.6±5.3)days in the non-reconstruction group(P<0.05);reconstruction group had good pronunciation in 10cases,moderate in 6cases,and poor in 4cases.Non-reconstruc-ted group had good pronunciation in 4cases,medium in 14cases,and poor in 5cases.Those with moderate or higher were compared no significant difference(P>0.05),and those with good pronunciation were statistically different(P<0.05).③The transverse and anteroposterior diameter in reconstruction group was similar with the normal people(P>0.05);however,the transverse and anteroposterior diameter in the non-reconstructed group was significantly different with that of the normal people(P>0.05),the transverse diameter of the reconstructed group and the non-reconstructed group were compared with no significant difference(P>0.05),but there was significant difference in the anteroposterior diameter between the two groups(P<0.05).The area in both groups were different with the normal people(P<0.05);④Glottic area morphology:the two groups of patients showed different degrees of swelling in the arytenoid cartilage area,the shape of the glottic region in the reconstructed group was approximately triangular,and the glottic morphology in the non-reconstructed group was approximately circular.Conclusion:After vocal cord reconstruction,there were increased rate of tracheal cannula extubation,well covered wallowing and phonation function,and the quality of life of patients was improved.