董 频, 於子卫, 金 斌, 孙臻峰, 祝江才, 王 桑, 谢 晋, 张 佳, 徐宏鸣. 改良额侧位喉部分切除及胸舌骨肌筋膜整复术[J]. 中国肿瘤临床, 2010, 37(16): 914-916. DOI: 10.3969/j.issn.1000-8179.2010.16.005
引用本文: 董 频, 於子卫, 金 斌, 孙臻峰, 祝江才, 王 桑, 谢 晋, 张 佳, 徐宏鸣. 改良额侧位喉部分切除及胸舌骨肌筋膜整复术[J]. 中国肿瘤临床, 2010, 37(16): 914-916. DOI: 10.3969/j.issn.1000-8179.2010.16.005
DONG Pin, YU Ziwei, JIN Bin, SUN Zhenfeng, ZHU Jiangcai, WANG Sang, XIE Jin, ZHANG Jia, XU Hongming. Modified Frontolateral Partial Larnygectomy with Reconstruction Using Sternohyoid Fascial Flap[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2010, 37(16): 914-916. DOI: 10.3969/j.issn.1000-8179.2010.16.005
Citation: DONG Pin, YU Ziwei, JIN Bin, SUN Zhenfeng, ZHU Jiangcai, WANG Sang, XIE Jin, ZHANG Jia, XU Hongming. Modified Frontolateral Partial Larnygectomy with Reconstruction Using Sternohyoid Fascial Flap[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2010, 37(16): 914-916. DOI: 10.3969/j.issn.1000-8179.2010.16.005

改良额侧位喉部分切除及胸舌骨肌筋膜整复术

Modified Frontolateral Partial Larnygectomy with Reconstruction Using Sternohyoid Fascial Flap

  • 摘要: 目的:研究额侧位喉部分切除术中使声门扩大提高拔管率或非气管切开的可行性,探讨其临床意义。方法:81例声门型喉癌,男78例,女3 例,其中T1 期54例,T2 期25例,单侧声带较广泛的重度不典型增生疑有恶变者2 例。额侧位喉部分切除术后,患侧组织缺损采用室带下拉与声门下缝合,胸舌骨肌内侧缘拉入喉前方与喉内前方切缘缝合,使甲状软骨外展前方扩大,喉前方以翻起的筋膜修补,使新喉腔呈“□”型,截面积增大。结果:切口均一期愈合,65例未行气管切开,39例术后有不同程度的皮下气肿,皆自行消退,全部患者于术后7~15d 出院。随访最长8.5 年,最短4 个月,6 例复发,均改行全喉切除,其中2 例再复发行胸大肌皮瓣修补,1~2 年内死亡,余均健在。结论:改良喉成型后,喉腔截面积扩大,部分可不做气管切开,是一种创伤小且有效的方法,可应用到垂直喉部分切除术、喉狭窄和术后不能拔管的患者。

     

    Abstract: Objective:To investigate the feasibility of raising the rate of extubation by enlarging the glottis or treating pa -tients without tracheostomy in modified frontolateral partial laryngectomy. Methods:A total of81patients with glottic carci-noma were included. There were 54T1 stage cases, 25T2 stage cases, and 2 cases with severe atypical hyperplasia in the lateral vocal cord. After frontolateral partial laryngectomy, the false vocal cord was drawn to the hypolarynx on the side of the lesion. The inner side of sternohyoid muscle was drawn into the laryngeal lumen and sutured to the incisional margin of the inner side of the laryngeal lumen. A reverted fascial flap was used to cover the anterior area to get a large laryngeal cav -ity, resulting in a ladder-shape laryngeal lumen. Results: The incision healed well in all patients. Sixty-five cases were treat-ed without tracheotomy. Thirty-nine patients had postoperative subcutaneous emphysema. All patients were discharged at 7 to 15days after surgery. Only 2 patients died at 1 to 2 years after surgery. Conclusion:The section area of laryngeal cavi-ty can be enlarged by modified laryngoplasty and some patients can even be treated without tracheostomy. Modified fronto -lateral partial laryngectomy can be used in patients after vertical partial laryngectomy, patients with laryngeal stenosis and those who cannot tolerate extubation.

     

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