舌骨肌瓣联合改良会厌瓣在晚期喉癌喉重建应用.docVIP

舌骨肌瓣联合改良会厌瓣在晚期喉癌喉重建应用【摘要】 目的 探讨晚期喉癌喉行喉部分切除术后喉功能重建的方法。方法 对有选择性的１６例Ｔ?３、Ｔ?４期喉癌患者行垂直侧前位喉次全切除（10例）或水平垂直部分喉切除术（６例），同期采用舌骨肌瓣联合改良会厌瓣进行喉功能重建。结果 随访３~５年，3年存活率为87．5%(14/16)、5年存活率为66．6%(6/9)，气管套管拔除率为87．5%(14/16)，发音功能及吞咽保护功能完全恢复。结论 晚期喉癌选择性施行喉功能保全性手术可行，采用舌骨肌瓣联合改良会厌瓣进行喉功能重建能有效恢复喉功能。? 【关键词】喉肿瘤；喉切除术；喉功能重建；生存率 ?? Application of hyoid muscular flap combining with modified epiglottis flap in laryngeal function reconstruction for advanced laryngocarcinoma LIN Xin，CHEN En-he，YANG Chu，et al. Department of Otorhinolaryngology Head and Neck Surgical ,Shantou Central Hospital, the Affiliated Shantou Hospital of Zhongshan University, Guangdong515031,China ? 【Abstract】 Objective To investigate the method of laryngeal function reconstruction after partial laryngectomy for advanced laryngocarcinoma． Methods Subtotal laryngectomy with vertical latero-anteposition was performed in 10 selected T?3~T?4 patients, and horizon-vertical partial laryngectomy was performed in the other 6 cases． Laryngeal function reconstruction with hyoid muscular flap combining with modified epiglottis flap was carried out at the same time． Results All cases were followed up for 3 to 5 years, with 3 year survival rate of 87．5%(14/16) and 5 year survival rate of 66．6%(6/9)． 87．5% (14/16) of tracheal cannula were pulled out, the voiced function and swallowing protection function were completely recovered． Conclusions Larynx function reserved operation was feasible for selected advanced laryngocarcinoma．Reconstruction applying hyoid muscular flap combining with modified epiglottis flap could restore the larynx function effectively．? 【Key words】 Laryngeal neoplasms ; Laryngectomy;Laryngeal function reconstruction ;Survival rate 晚期喉癌由于侵犯范围广泛，往往需要切除大部分喉内、外组织，喉功能重建难度大。汕头市中心医院耳鼻咽喉头颈外科自1998年1月至2006年3月有选择性对16例Ｔ?３、Ｔ?４期喉癌患者行喉部分切除术，同期应用舌骨肌瓣联合改良会厌瓣进行喉功能重建，疗效满意，现报告如下。? 1 资料和方法? 1．1 临床资料 16例晚期喉癌患者，病理均证实为鳞状细胞癌，男15例，女1例，年龄41～72岁，平均58．2岁。按1997年UICC修订案分期声门型11例中T?3N0 5例，T?3N1 4例，T?4N1 2例 ，声门上型5例中T?3N1 4例，T?3N2