声带癌切除颈皮肌瓣修复成型喉功能重建术的临床研究.doc

声带癌切除颈皮肌瓣修复成型喉功能重建术的临床研究 刘强﹡ 陈登巨 作者单位：223300 江苏淮安，南京医科大学附属淮安第一医院 耳鼻咽喉科 ﹡通讯作者：刘强，Email:lqiange001@ 【摘要】目的 探讨颈皮肌瓣修复声带癌缺损创面重建喉功能的临床效果。方法 回顾分析2005年1月~ 2010年4月我科住院治疗的的声带癌患者31例临床资料。结果 31例采用颈阔肌肌皮瓣喉成形术的患者，术后12d有29例顺利拔除气管套管，1例2个月后拔管，拔管率96.77%。未发生呼吸不畅，全部病例鼻饲管留置7～10d，试饮水无误咽后拔除经口进食，无误咽现象。术后6月发音功能判定， I~ = 3 \* ROMAN III级能发音者占93.55 ％。术后均未发生因喉狭窄引起的呼吸困难，术后5例出现伤口感染，2 例出现咽瘘。随访3月~5年，术后5年死于肿瘤复发12.90%，局部复发6.45%，颈部复发16.13% ；其余病人健在，5年生存率为87.10％ 。结论 声带癌喉部分切除术，应用带蒂颈阔肌肌皮瓣进行喉腔创面重建，喉功能恢复效果良好。 【关键词】喉癌；外科皮瓣；喉切除术 Neck skin cancer resection vocal cord muscle flap reconstruction of laryngeal function in shaping the clinical study 【Abstract】? Objective：Of neck skin muscle flap reconstruction of vocal cord cancer, laryngeal function defect of the clinical effect.Methods: Review of January 2005 ~ April 2010 I inpatient treatment of vocal cord cancer clinical data in 31 patients. Results: 31 patients were platysma muscle flap laryngoplasty in patients after 12d with 29 cases successfully extubated tube, 1 case 2 months after extubation, extubation rate 96.77%. Not occurring dyspnea in all cases feeding tube indwelling 7 ~ 10d, try drinking water and correct removal of food by mouth after throat, pharynx and correct behavior. After 6 months of pronunciation features determined, I ~ III level can pronounce accounted for 93.55%. Occurred because of laryngeal stenosis after surgery were not caused by breathing difficulties, after 5 patients had wound infection, 2 cases of pharyngeal fistula. Followed up for 3 months to 5 years, died of tumor recurrence after 5 years 12.90%, 6.45% local recurrence, neck recurrence 16.13%; the rest of the patients alive, 5-year survival rate was 87.10%.Conclusions: Partial laryngectomy vocal cord cancer, pedicled platysma muscle flap reconstruction of the throat wound, laryngeal function effectively. 【Key words】Larynx; surgical flaps; laryngectomy 喉癌是喉科常见疾病，占头颈部恶性肿瘤的13.9％，仅次于鼻咽癌位于第3位[1]。声带癌是喉癌中最多见的一种，约占60 %，分化好，在早期时很少发生颈淋巴转移，因此手术的疗效好。但术后患者常遗留发声困难，影响日常交流，如何一期修复病变组织切除后的缺