保留部分环状软骨环的喉全切除术

目的研究喉癌及下咽癌手术中保留部分环状软骨环对患者的影响。方法回顾性分析32例中晚期喉癌、下咽癌患者,术中采取于环状软骨弓中部水平裂开,只保留部分环状软骨环的喉全切除术,保留的部分环状软骨环与气管一起与颈前造瘘,术后患者不佩戴全喉套管,观察患者咳嗽反射、气道分泌物、造瘘口变化及出院后有无造瘘口狭窄及造瘘口复发情况。结果 32例患者术后均咳嗽反应及气道分泌物明显减少,造瘘口周围红肿较轻。术后随访12~60个月,造瘘口无明显狭窄,无造瘘口肿瘤复发。结论中晚期喉癌及下咽癌患者保留部分环状软骨环的喉全切除术,可避免术后佩戴全喉套管,减少刺激性咳嗽,减轻局部炎症反应,更有利于气道分泌物的排出,缩短患者术后恢复时间,预防气管造瘘口狭窄。

Total laryngectomy with partial preservation of the ericoid cartilage ring

Objective To explore the effect of partial preservation of the cricoid cartilage ring in total laryngectomy.Method The clinical data of 32 patients with laryngeal carcinoma or hypopharyngeal carcinoma were analyzed retrospectively.All patients underwent total laryngectomy with partial preservation of the cricoid cartilage ring.The cricoid cartilage arch was opened at the midline.Tracheostomy was performed with partial preservation of the cricoid cartilage ring.The tracheostomy was monitored postoperatively for inflammatory reactions,stenosis,and tumor recurrence.Results Of 32 patients who underwent this new tracheostomy technique following total laryngectomy,none required postoperative tracheal cannulation.The inflammatory reaction was less than with traditional tracheostomy.There was no tracheostomy stenosis or tumor recurrence during 12 to 60 months of follow-up.Conclusion Some patients with advanced laryngeal or hypopharyngeal carcinoma underwent partial preservation of the cricoid cartilage ring during total laryngectomy and none required postoperative tracheal cannulation.This new tracheostomy technique not only reduced inflammatory reactions,irritating cough,and tracheostomy stenosis,but also shortened the time of postoperative recovery.