喉部分切除带蒂颈阔肌皮瓣喉成形术对累及双侧声带喉癌患者呼吸及吞咽功能的影响

Effects of laryngoplasty with pedicled platysma myocutaneous flap after partial laryngectomy on respiratory and swallowing function in patients with laryngeal cancer involving bilateral vocal cords

目的研究喉部分切除带蒂颈阔肌皮瓣喉成形术对累及双侧声带喉癌患者呼吸及吞咽功能的影响。方法前瞻性选取2019年4月至2021年4月68例于青岛大学附属医院行颈阔肌肌皮瓣修复喉腔的喉癌患者作为研究对象,采用随机数字表法将两组患者均分为实验组(n=34)和对照组(n=34)。两组患者均接受喉部分切除术,对照组采用带状肌筋膜喉成形术,实验组则采用带蒂颈阔肌皮瓣喉成形术。比较两组患者临床指标;比较两组患者术后拔管情况、吞咽功能等级以及并发症发生率;比较两组患者手术前后声带功能指标(基频微扰、振幅微扰和基频)。结果实验组患者手术时间和黏膜恢复时间分别为(72.36±1.43)min、(4.69±0.78)d,显著短于对照组[(120.74±1.29)min、(6.14±0.81)d],差异均有统计学意义(P<0.05)。实验组患者拔管时间为(10.21±1.47)d,显著短于对照组[(14.72±1.52)d]组,无误咽占比为82.35%,高于对照组(44.11%),中度误咽占比为0,低于对照组(41.17%),差异均有统计学意义(P<0.05)。实验组患者并发症发生率为2.94%,显著低于对照组(17.64%),差异有统计学意义(P<0.05)。手术后,两组患者基频微扰、振幅微扰和基频均显著降低,且实验组患者基频微扰、振幅微扰和基频分别为(0.24±0.04)%、(1.71±0.29)%、(141.69±10.22)Hz,均显著低于对照组[(0.37±0.05)%、(2.12±0.31)%、(152.43±10.33)Hz],差异均有统计学意义(P<0.05)。结论喉部分切除带蒂颈阔肌皮瓣喉成形术对累及双侧声带喉癌患者呼吸及吞咽功能的改善效果较高,且安全性较高。

Objective To study the clinical effects of laryngoplasty with pedicled platysma myocutaneous flap after partial laryngectomy on respiratory and swallowing function in patients with laryngeal cancer involving bilateral vocal cords.Methods Sixty-eight patients with laryngeal cancer receiving platysma myocutaneous flap for the repair of laryngeal cavity in Affiliated Hospital of Qingdao University from April 2019 to April 2021 were selected,and were divided into two groups by the random number table methods,each with 34 cases.Both groups received partial laryngectomy.After that,control group received laryngoplasty with strap muscular flap,while experimental group received laryngoplasty with pedicled platysma myocutaneous flap.Then the parameters including clinical indexes,postoperative extubation,grade of swallowing function,complication rate,and the vocal cord function indexes(fundamental frequency perturbation,amplitude perturbation and fundamental frequency)of the two groups of patients were compared before and after surgery.Results The operation time and mucosal recovery time in the experimental group were(72.36±1.43)min and(4.69±0.78)d,which were significantly shorter than those in the control group[(120.74±1.29)min and(6.14±0.81)d],and the difference was statistically significant(P<0.05).The extubation time of patients in the experimental group were(10.21±1.47)days,which were significantly shorter than those in the control group[(14.72±1.52)days],the proportion of no swallowing was 82.35%,which was higher than that in the control group(44.11%),the proportion of moderate swallowing was 0,which was lower than that in the control group(41.17%),and the differences were statistically significant(P<0.05).The incidence of complications in the experimental group was 2.94%,which was significantly lower than that in the control group(17.64%),and the difference was statistically significant(P<0.05).After surgery,the fundamental frequency perturbation,amplitude perturbation and fundamental frequency of patients in the two groups were significantly reduced,and the fundamental frequency perturbation,amplitude perturbation and fundamental frequency of patients in the experimental group were(0.24±0.04)%,(1.71±0.29)%,(141.69±10.22)Hz,which were significantly lower than those in the control group[(0.37±0.05)%,(2.12±0.31)%,(152.43±10.33)Hz],and the differences were statistically significant(P<0.05).Conclusion Laryngoplasty with pedicled platysma myocutaneous flap after partial laryngectomy in patients with laryngeal cancer involving bilateral vocal cords can effectively and safely improve the respiratory and swallowing function.