异种脱细胞真皮基质促进喉癌内镜下Ⅴa型声带切除术后创面修复的临床观察

Heterogeneous acellular dermal matrix for wound repair after endoscopic Type-Ⅴa cordectomy

目的:观察异种脱细胞真皮基质(acellular dermal matrix,ADM)修复膜植入对声门型喉癌CO_(2)激光Ⅴa型声带切除术后喉腔创面修复的临床疗效。方法:选择2018年3月-2019年12月在中南大学湘雅二医院耳鼻咽喉头颈外科接受内镜下CO_(2)激光手术的35例双侧声带病变喉癌患者为研究对象并分为2组,其中研究组18例,对照组17例,对照组单纯植入硅胶管喉模支架,研究组则在硅胶管外衬ADM,观察2组患者术后喉腔创面的修复情况及相关临床表现。结果:术后6个月喉腔创面比较,研究组均无肉芽组织残留,对照组4例患者有肉芽残留;研究组3例患者出现中重度喉粘连,对照组9例患者出现中重度喉粘连;对照组10例患者表现为2~4度喉梗阻,研究组仅4例出现相同情况。结论:ADMⅠ期植入不仅能够减少喉癌CO_(2)激光Ⅴa型声带切除术后喉腔肉芽、喉粘连,还可能减少术后喉梗阻的发生。

Objective To observe the clinical effect of placing heterogeneous acellular dermal matrix membrane for laryngeal cavity wound healing after CO_(2)laser Type-Ⅴa cordectomy for glottic carcinoma.Methods Thirty-five patients with bilateral vocal cord laryngeal cancer who underwent endoscopic CO_(2)laser surgery at the Department of Otorhinolaryngology Head and Neck Surgery,the Second Xiangya Hospital of Central South University from March 2018 to December 2019 were selected and divided into 2 groups,including 18 patients in the study group and 17 patients in the control group.The control group was simply placed silicone tube stent,while in the study group,heterogeneous acellular dermal matrix membrane was coated with silicone tube stent.The postoperative laryngeal wound repair and clinical manifestations were observed and compared between the two groups.Results Compared postoperative laryngeal wound after 6 months:no patients in the study group had granulation tissue,whereas 4 patients in the control group had granulation tissue;3 patients in the study group developed moderate to severe tissue adhesion,while 9 patients in the control group;10 patients in the control group developed 2nd to 4th degree laryngeal obstruction,compared with only 4 patients in the study group.Conclusion The primary placement of ADM can reduce laryngeal granulation tissue and tissue adhesion after CO_(2)laser Type-Ⅴa cordectomy for laryngeal cancer,and may reduce the occurrence of postoperative laryngeal obstruction.