环舌根会厌吻合术对减轻误咽提高拔管率的探讨

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Study of mechanisms of lightening aspiration and increasing decannulation rate in anastomosis of cricoid cartilage and base of tongue ( epiglottis)

Objective To study laryngopharyngeal anastomosis and fixing methods of supracricoid laryngectomy with reconstruction of functions in lightening aspiration and increasing decannulation rate. Methods Recovering conditions of laryngeal functions in 66 patients who underwent supracricoid laryngectomy and anastomosis of cricoid cartilage and base of tongue (epiglottis) in recent eight years were summarized. Some relevant caliber distances in 21 residual larynxes were measured. Results All cases restored their phonation. In 36 cases that underwent anastomosis of cricoid cartilage and base of tongue, 15 cases without aspiration, 18 with mild aspiration, 3 moderates. Decannulation rate is 94.4%. In 30 cases who underwent anastomosis of cricoid cartilage and base of tongue, 10 with mild aspiration, 17 moderate, 3 serious. All cases overcame aspiration within 3 weeks. 7 cases were not decannulated. 3,5,10 year survival rates were 80.3%,74.4%,and 3/7. The longitudinal and transverse calibers of epiglottis were 1.5-2.0 times longer than that of the entrance of cricoid cartilage. After anastomosis of cricoid cartilage and base of tongue (epiglottis), the epiglottis can exactly cover the entrance of cricoid cartilage to prevent aspiration fully and increase decannulation rate. Previously the cricoid cartilage was anatomized and fixed under the hyoid bone. Because some spaces exist between cricoid cartilage, base of tongue and epiglottis, aspiration is likely to occur. That hyoid bone covers the entrance of cricoid cartilage will bring constriction of the new laryngeal orifice and make decannulation difficult. Hyoidectomy and anastomosis of cricoid cartilage and base of tongue (epiglottis) overcame the two shortcomings and had good effects. Conclusion Cricohyoidopexy was the main reason of severe aspiration and low decannulation rate. The ideal methods to lighten aspiration and increase decannulation rate are hyoidectomy and anastomosis of cricoid cartilage and base of tongue (epiglottis).