可吸收胶原膜在累及前联合的声门型喉癌手术中的应用

Application of absorbable collagen membrane in surgery of glottic carcinoma involving anterior commissure

目的探讨可吸收胶原膜一期置入在累及前联合的声门型喉癌内镜手术中的应用价值及治疗效果。方法累及前联合的声门型喉癌患者19例,全麻支撑喉镜下行喉肿瘤切除术,同期放置修剪合适大小可吸收胶原膜并经环甲膜固定,1~2周后根据胶原膜贴敷情况去除喉外固定缝线。所有患者术后随访6个月至5年,随访内容包括:声带创面恢复情况;前联合形态;嗓音障碍指数量表(VHI)、最长发音时间(MPT)及嗓音障碍严重指数(DSI)。结果①术后随访时,除1例患者术后1个月复查时发现肿瘤残余复发,3例患者声带前三分之一粘连,其余15例患者均未出现呼吸困难且声带前联合获得良好三角形形态,对比既往5例未放置可吸收胶原膜同分期患者,均获得满意的声门形态;②术后疼痛评分中17例(89.5%)轻度疼痛,2例(10.5%)中度疼痛,均无重度疼痛;③术后半年黏膜功能稳定后行嗓音功能评估,VHI手术前后(60.63±12.93 vs 19.37±5.73),差异具有统计学意义(P<0.001);客观声学参数MPT手术前后(10.07±1.47 vs 14.40±1.48),差异具有统计学意义(P<0.001);DSI手术前后(-1.52±4.20 vs 0.97±2.12),差异均具有统计学意义(P<0.001)。结论一期置入可吸收胶原膜可预防累及前联合声门型喉癌切除术后双侧声带粘连,且患者术后疼痛感轻微,可促进患者术后喉功能的恢复,无不良反应发生。

Objective To explore the application value and therapeutic effect of one-stage implantation of absorbable collagen membrane in the endoscopic laryngeal surgery of glottic carcinoma involving anterior commissure.Methods A total of 19 patients with glottic carcinoma involving anterior commissure underwent endoscopic laryngeal tumor resection under general anesthesia.At the same time,the trimmed absorbable collagen membrane with an appropriate size was placed and fixed with cricothyroid membrane.One to two weeks after surgery,the external laryngeal fixation suture was removed according to the applied situation of collagen membrane.All patients were followed up for 6 months to 5 years.The contents of the follow-up included the state of vocal cord wound recovery,morphology of the anterior commissure,voice handicap index(VHI),maximum phonation time(MPT)and dysphonia severity index(DSI).Results①During the postoperative follow-up,except for residual tumor recurrence in one patient and adhesion of the anterior third of the vocal cords in 3,the remaining 15 patients did not have dyspnea and restored normal triangle-shaped anterior commissure anatomy.Compared with the previous 5 patients of the same stage without absorbable collagen membrane,satisfactory glottic shape was achieved in all cases.②As for the postoperative pain,17 cases(89.5%)were mild,2(10.5%)were moderate,and none of them were severe.③The voice function assessments were performed when the mucosal function was stable at half one year after operation.The pre-and postoperative differences of VHI(60.63±12.93 vs 19.37±5.73),MPT(10.07±1.47 vs 14.40±1.48)and DSI(-1.52±4.20 vs 0.97±2.12)were all statistically significant(all P<0.001).Conclusion The first-stage implantation of absorbable collagen membrane can prevent vocal cord adhesion after resection of glottic laryngeal carcinoma involving anterior commissure,promote the recovery of postoperative laryngeal function with mild postoperative pain and without adverse reactions.