双蒂双肌瓣在T3和T4喉癌扩大喉部分切除术中的应用

Application of bi-pedicel and bi-muscle flaps for the expanded partial laryngectomy in the patients with T3T4 laryngeal cancer

目的 观察双蒂双肌瓣在T3、T4喉癌喉扩大部分切除术中应用的远期疗效。方法19 90年 5月～ 1997年 5月对 3 86例喉癌T3、T4病变行喉扩大部分切除术 ,同时应用单侧或双侧双蒂双肌瓣进行修复喉腔大面积缺损 ,重建喉功能 ,手术方法包括 :扩大声门上水平喉部分切除术 ,扩大垂直喉部分切除术 ,3 / 4喉部分切除术及喉次全切除术。结果 术后 8～ 12d拔除鼻饲管 ,气管套管拔除率 50 3 % (194/ 3 86)。 3年和 5年生存率分别是 76 7% (2 96/ 3 86)和 55 2 % (2 13 / 3 86) ,局部复发率为 16 6% (64/ 3 86)。结论 双蒂双肌瓣扩大了T3、T4喉癌喉部分切除术的适应证 ,只要把握好双蒂双肌瓣应用的适应证 ,可使部分晚期喉癌患者免除喉全切除之苦 ,提高了患者的生存质量 ,并发症少。

Objective To evaluate the application of bi-pedicel and bi-muscle flaps for the expanded partial laryngectomy in the patients with T3T4 larynx caner Methods From 1990 to 1997, 386 patients of laryngeal cancer were treated by expanded partial laryngectomy and repaired with unilateral or bilateral bi-pedicel and bi-muscle flaps 322 patients were male and 64 were female The age ranged from 30 to 84 years old All the patients were in the stage T3 or T4 of cancer The operation included expanded horizontal supraglottic laryngectomy, vertical partial laryngectomy, 3/4 laryngectomy and sub-total laryngectomy Results After operation, the speech function was still good in all cases The swallow function recovered in 8 to 12 days post-operation The extraction rate of tracheal tube was 50 3% (194/386), and the 5-years survival rate was 55 2% (213/386) while the local recurrence rate was 16 6% (64/386) Conclusion With the application of bi-pedicel and bi-muscle flaps, the patients, if treated by total laryngectomy as traditional technique, could be treated by partial laryngectomy This method could expand the indication of partial laryngectomy and improve the life quality and survival rate