超薄型钛网和带状肌筋膜瓣在额侧垂直部分喉切除术后喉功能重建中的应用

Clinical study about anatomical and functional reconstruction for frontolateral vertical partial laryngectomy with ultrathin titanium mesh and fascia flap from the strap muscles

目的:探讨T2、T3声门型喉癌患者行额侧垂直部分喉切除术后,应用超薄型钛网和带状肌筋膜瓣行喉功能重建的效果。方法:10例T2、T3声门型喉癌患者行不同范围的额侧垂直部分喉切除术,术中一期应用超薄型钛网塑形成甲状软骨形态,拼接法内衬甲状软骨膜和带状肌筋膜,恢复喉支架功能,术后观察发声、吞咽以及拔管率。结果:9例患者术后2~4周内拔管,1例患者术后喉狭窄,经硅胶管扩张术后3个月拔管。所有患者吞咽及发声功能恢复良好,无误咽发生。钛网组织相容性良好,无移位,喉腔无钛网裸露。结论:超薄型钛网联合甲状软骨膜和带状肌筋膜重建喉功能手术适合于以前连合为中心侵犯双侧声带、声门上下扩展的T2、T3期声门型喉癌患者,部分会厌根部和环甲膜受侵患者仍适用该术式。该手术具有方法简单、拔管率高、喉功能恢复良好的优点。

Objective:To investigate the effect of laryngeal reconstruction in functional and anatomical aspect with ultrathin titanium mesh and myofascial flap in patients underwent frontolateral vertical partial laryngectomy with T2 and T3 glottic laryngeal carcinoma.Method:Ten patients with T2 and T3 glottic laryngeal carcinoma underwent frontolateral vertical partial laryngectomy in different range.The ultrathin titanium mesh was shaped up according to the form of thyroid cartilage in operation while the thyroid perichondrium membrane combined with straped myofascial flap was lined under the titanium mesh to restore the laryngeal cavity space.The pronunciation,swallowing capability and extubation rate were observed after surgery.Result:Nine patients underwent extubation within 2 to 4 weeks after surgery,one patients remove metal tube in two-stage after laryngeal dilation surgery with the Montgomery tube.Swallowing and voice function in these patients recovered well and no deglutition disorder was found.CT scan showed that the Titanium meshs were fixed well without displacement and deformity.Electronic laryngoscopy showed that the mucosa of laryngeal lumen was smooth without laryngeal stenosis,keloid contraction,tissue necrosis or titanium mesh exposure.Conclusion:In the cases of T2,T3 glottic laryngeal cancer patients,laryngeal framework reconstruction with the new type of ultrathin titanium mesh,thyroid cartilage membrane and pedicled fascia plap of strap muscles is a good choice after the vertical frontolateral partial laryngectomy.Even some elective T4 cases with the former part invasion in supra-glottic or infra-glottic region can receive this operation.It can reconstruct the physiological and anatomical structure of the larynx,restore laryngeal function with a sound decanulization rate.