支撑喉镜下超声刀无气管切开水平部分喉切除术

会厌癌是最常见声门上型喉癌之一,约占喉部恶性肿瘤的25%,近年来略有增长,且男性发病率远高于女性。会厌癌可局限于会厌或侵及杓会厌襞者、咽会厌皱襞,向下可侵及室带等。大多采用开放的声门上喉部分切除术治疗或支撑喉镜下CO2激光切除等外科手术方法,需行气管切开。本文报道支撑喉镜下超声刀手术切除治疗会厌癌(Epiglottis carcinoma)1例,行双侧颈部淋巴结清扫但未行气切。总结超声刀的手术技巧及优点,并结合文献进行讨论。     

会厌在喉部分切除喉功能重建术中的应用

目的　探讨会厌在喉部分切除喉功能重建术中的应用价值。方法　 1 992年 1 2月～1 996年 1月 32例不同分期的声门型、声门上型喉癌行喉部分切除术 ,将残存会厌下移保留喉功能。结果　 2 1例声门型喉癌术后 1 9例拔除气管套管恢复喉的全部功能 ;1 1例声门上型喉癌 5例恢复喉全部功能 ,并于术后 1 4～ 1 8d恢复吞咽功能 ,无 1例出现误吸引起严重并发症。 3年生存率 87 5 %(2 8/ 32 ) ,5年生存率 5 8 3%(7/ 1 2 )。结论　喉部分切除喉功能重建术中会厌取材方便 ,无需重新进行皮肤切口 ;其喉面有完整粘膜 ,创面愈合时间短 ;喉结构重建扩大了喉的左右径 ,提高了术后拔管率同时防止误咽发生 ,对提高喉部分切除术患者术后生存质量有一定作用。     

会厌在喉部分切除喉功能重建术中的应用

目的 探讨会厌在喉部分切除喉功能重建术中的应用价值。方法 １９９２年１２月－１９９６年１月３２例不同分期的声门型,声门上型喉癌行喉部分切除术,将残存会厌下移保留喉功能。结果 ２１例声门型喉癌术后１９例拔除气管套管恢复喉的全部功能,１１例声门上型喉癌５例恢复喉全部功能,并于术后１４－１８ｄ恢复吞咽功能,无１例出现误吸收起严重并发症。３年生存率８７．５％（２８／３２）,５年生存率５８．３％（７／１２）     

Epiglottic reconstruction after near total laryngectomy

Near total laryngectomy results in large defect of the larynx requiring reconstruction. Pedicled composite epiglottic flap containing cartilage and epithelium is an ideal reconstructive tissue. This paper describes our experiences with 15 cases who underwent epiglottic laryngoplasty after near total laryngectomy since 1983. In order to avoid too wide a glottis leading to aspiration and poor voice, the Tucker technique has been modified in two ways: (1) The posterior edge of the epiglottis was sutured separately to the posterior edge of the cricoid opposing the true and false cords rather than the thyroid alar struts; An arytenoid was reformed. (2) Bilateral edge of the epiglottis was lowered. Anew pseudocord was formed. (3) The anterior epiglottic flap was manipulated to simulate the shape of anterior commissure. These modified reconstructive techniques resulted in decreasing in the transverse diameter and increasing slightly in the anterior-posterior length of the glottis, the functions of deglutition, phonation and respiration were improved significantly None had developed local recurrence and distant metastasis in more than 2-4 years.     

喉环上部分切除术及其疗效

目的 探讨喉癌行喉次全切除术并重建喉功能的术式及其疗效。方法 １９７８～１９９８年行喉次全切除环－舌骨固定术或环－舌骨－会厌固定术２９例,其中男１８例,女１１例;年龄最大７０岁,最小３８岁,平均５５．４岁。按１９８７年ＵＩＣＣ分期,全部均为Ｍ０,声门上型１０例（Ｔ２Ｎ０ ３例、Ｔ２Ｎ１ １例、Ｔ３Ｎ０ ３例、Ｔ３Ｎ１ ２例,Ｔ３Ｎ２ １例）,声门型１９例（Ｔ２Ｎ０ １２例、Ｔ２Ｎ１ １例、Ｔ３Ｎ０     

Rehabilitation des Schluckvermögens nach Tumorresektion

BACKGROUND: Patients with supraglottic laryngectomy often complain about persisting dysphagia because the resection includes the most important protective mechanisms of the airway. The additional resection of parts of the tongue base or the lateral hypopharyngeal wall leads to increasing aspiration problems. PATIENTS AND RESULTS: Reconstruction of the supraglottic region with a free radial forearm flap and septal cartilage in extended oro-hypopharyngeal and laryngeal carcinomas was carried out in seven patients from 1997 to 2002. In one patient, the reconstruction was performed in a second stage procedure after extended endoscopic laser resection. In four patients, the temporary tracheostomy was closed, and in five total oral feeding was possible. CONCLUSIONS: Preliminary results show that a functional reconstruction of the supraglottic region with a free radial forearm flap and septal cartilage to reconstruct the epiglottis helps to avoid chronic aspiration and to preserve the larynx.     

Swallowing function after endoscopic resection of supraglottic carcinoma with the carbon dioxide laser

From April 1998 to May 2000, 14 patients with supraglottic cancer underwent transoral laser surgery (T-stage T1-2: 11 patients, T3: 3 patients). In three patients, an epiglottectomy or hemi-epiglottectomy was performed. In 11 patients, further structures (false cords, the valleculae and the base of the tongue and/or parts of the arytenoid cartilage) had to be resected. Thirteen patients had to undergo neck dissection and post-operative irradiation. Tracheostomy was carried out prophylactically in two cases. Every patient received a nasogastric tube perioperatively. One week after surgery, an evaluation of dysphagia was performed by video endoscopy (VEED). Aspiration was the main problem; in no case did dysphagia occur. The aspiration was graded according to videolaryngoscopical classification. Four patients had an occasional and ten patients a permanent aspiration after surgery. According to this assessment, an individual deglutition therapy management was established. Ten patients with permanent aspiration received a temporary percutaneous endoscopic gastrostomy (PEG) and were integrated in a rehabilitation programme (stimulation of the swallowing reflex, training of compensatory swallowing manoeuvres, dietary regime). Due to this training programme, the PEG could be removed in eight patients after 2-9 months. No patient needed a laryngectomy or a tracheostomy due to aspiration. There were no cases of aspiration-associated pneumonia. To obtain satisfying functional results after transoral laser surgery of supraglottic cancers with resection of the epiglottis, post-operative deglutition management, consisting of video endoscopy, a training programme and often a PEG, is necessary.     

Epiglottic suture for treatment of laryngomalacia

OBJECTIVES: To present a technique for surgical management of laryngomalacia directed against the basic abnormality of the disease. Considering the cause-consequence relations of the abnormalities, we can distinguish two types of laryngomalacia. In the first, the basic abnormality is the pathological shape of the epiglottis: the epiglottis, which normally stands in an upright position, is characteristically excessively folded, restricting the supraglottic space directly as well as indirectly due to the proximity of the aryepiglottic folds that are attached to its lateral edges. In the second type the abnormality is the backward displacement (ptosis) of a normally shaped epiglottis. All other abnormalities are the consequences of these basic abnormalities. We present a new procedure, the epiglottic suture, to correct the pathological shape of the epiglottis. It is a suture placed transversely on the lingual surface of the epiglottis that unfolds the folded epiglottis and shifts apart the adjacent aryepiglottic folds. PATIENTS AND METHODS: Prospective non-randomized study performed on eight severely distressed patients with laryngomalacia at the University Department for Otorhinolaryngology and Cervicofacial Surgery, Ljubljana, Slovenia. RESULTS AND CONCLUSION: The epiglottic suture enabled normal breathing in all treated children without compromising the airway-protection function of the epiglottis. After an average follow up time of 19.12 months (minimum 7 months and maximum 27 months), we have not noticed any complications or deteriorations of breathing.     

Isolated adult supraglottic stenosis: surgical treatment and possible etiologies

Isolated supraglottic stenosis in adults without a history of laryngeal injury is a rare and poorly described clinical entity. We report a case of a 61-year-old woman who presented with near total airway obstruction and a diagnosis of an epiglottic mass. She required a tracheotomy for definitive airway control. Initial diagnostic laryngoscopy and biopsies revealed isolated supraglottic stenosis due to fibrosis with acute and chronic inflammation. The patient had a medical history of gastroesophageal reflux disease and hiatal hernia and no history of laryngeal trauma. Transoral supraglottic laryngectomy was required for definitive treatment. Isolated supraglottic stenosis may be seen in children with congenital laryngotracheal anomalies, as a sequelae of prolonged orotracheal intubation or after laryngeal trauma or tumor surgery. Other causes may include autoimmune and inflammatory disorders. Gastroesophageal reflux disease may also contribute to the disease process of isolated supraglottic stenosis. Supraglottic laryngectomy is a feasible treatment option for isolated supraglottic stenosis and may allow for tracheostomy decannulation.     

Hypoplasia of the epiglottis in a middle-aged man

Hypoplasia of the epiglottis diagnosed at adulthood is extremely rare. Most patients with epiglottic hypoplasia have presented life-threatening symptoms of respiratory distress and severe aspiration in infancy or early childhood. This is a case of congenital epiglottic hypoplasia found in a 42-year-old man complaining of mild hoarseness and throat discomfort. Strobolaryngoscopy and CT scans revealed a unique anomaly with isolated epiglottic hypoplasia and normal appearance of other laryngeal structures. This case is discussed with a review of the literature on this rare occurrence.     

Relationship between dysphagia and surgical treatment for supraglottic laryngeal carcinoma: A meta-analysis

ObjectiveTo systematically evaluate differences in swallowing disorder-related manifestations in patients with supraglottic laryngeal cancer, who underwent traditional open partial horizontal laryngectomy (OPHL) and endoscopic supraglottic laryngectomy (ESL).MethodsA systematic review of the literature and a meta-analysis were performed. The CNKI, Wan Fang, PubMed, EMBASE, Cochrane Library, Web of Science, and Clinical Trials databases for clinical studies data sources were investigated. The efficiency of recovery, postoperative swallowing function, and complications related to dysphagia were investigated to compare the effects of surgical procedures.ResultsThe meta-analysis included 8 studies with 281 patients. ESL surgery played a positive role in the recovery of patients. Preservation of the anterior epiglottic space, ventricular band, and arytenoid cartilage without destroying the external framework of the larynx can effectively reduce the risk of aspiration pneumonia in patients.ConclusionsESL has advantages in postoperative recovery and retention of swallowing function in patients with supraglottic laryngeal cancer.     

Transoral Partial Supraglottic Resection Using The CO2 Laser

Transoral epiglottis resection or partial supraglottic resection was done with the CO₂ laser in 20 highly selected patients. Visualization was best accomplished using the Lynch suspension system, but was satisfactory with the Jako-Pilling laryngoscope. The best indications for this procedure were: 1. for visualization of the true vocal cords in previously treated cancer patients whose epiglottis obstructed indirect mirror examination, 2. for removal of obstructing benign epiglottic lesions, 3. as an excisional biopsy in limited epiglottic cancer, especially of the suprahyoid epiglottis. No major complications or operative morbidity occurred. This approach obviated the potential morbidity of external surgical procedures in a select group of patients. Shortened hospitalization, avoidance of tracheotomy, minimal postoperative discomfort and edema, and excellent wound healing were additional advantages seen.     

Near-total laryngectomy with epiglottic reconstruction. Long-term results

A previous report reviewed the technique and indications for near-total laryngectomy with epiglottic reconstruction in the management of squamous cell carcinoma of the glottis. This approach permits removal of most of both vocal folds, with immediate reconstruction using the epiglottis without the need for stenting or multistage procedures. Forty-eight patients underwent the procedure and were followed up for at least 2 years or until death. Seventeen underwent the surgery for recurrence after failure of radiation therapy for cure. Complications included one wound infection and one laryngocutaneous fistula. All patients underwent decannulation, with little or no compromise of swallowing. All but 1 now have functional voices. Of 8 patients with recurrence, 6 have been salvaged. Two patients died of disease. The value of near-total laryngectomy with epiglottic reconstruction for management of glottic cancer is reviewed.     

Epiglottoplasty for reconstruction of posttraumatic laryngeal stenosis

Laryngeal stenosis secondary to blunt laryngeal trauma is mostly localized at the supraglottic and glottic levels. The epiglottis is ideally suited to reconstruct the defect after excision of supraglottic and glottic scar tissue and anterior thyroid cartilage. It is the conclusion of the authors that epiglottic reconstruction is an effective procedure for repair of laryngeal stenosis at the supracricoid level. Two case reports are given.     

声门上水平喉部分切除术中舌骨去留对误咽的影响

目的 探讨声门上水平喉部分切除术中保留与切除舌骨对误咽的影响。方法 回顾分析1998年1月至2011年10月菏泽市立医院耳鼻咽喉科收治的39例声门上型喉癌行声门上水平喉部分切除术的临床资料, 将其中年龄在56~67岁且无脑血管病、神经系统疾病及呼吸系统疾病的声门上型喉癌(T₁~T₃)行声门上水平喉部分切除术的39例患者作为观察对象, 其中19例未切除舌骨, 20例切除舌骨。结果 病例切缘均为阴性, 发声接近正常, 拔管率为100%;保留舌骨的19例中, 2例(10.5%)有轻度误咽, 10例(52.6%)中度误咽, 7例(36.8%)重度误咽, 误咽恢复时间为(31±3)d;2例并发吸入性肺炎。切除舌骨的20例中, 轻度误咽11例(55.0%), 中度误咽9例(45.0%), 无重度误咽, 误咽恢复时间为(15±2)d;无吸入性肺炎发生。结论 声门上水平喉部分切除术中切除舌骨、充分利用舌根对声门的遮盖作用, 可有效减轻术后误咽程度, 缩短误咽恢复时间, 防止或减少吸入性肺炎的发生。     

梨状窝粘膜修复喉部分切除术后的粘膜缺损

目的 :探讨应用梨状窝粘膜修复喉部分切除术后粘膜缺损及恢复喉功能的效果。方法 :对 198例患者施行此术式 ,其中喉水平部分切除术 87例、喉垂直部分或扩大喉垂直部分切除术 6 5例、喉水平加垂直部分切除术 4 6例。同时进行随访观察。结果 :喉水平部分切除术者拔管率为 10 0 % ;术后发音、呼吸、吞咽功能恢复好 ;5年生存率为 84 .7%。喉垂直部分或扩大喉垂直部分切除术拔管率为 87.7% ;5年生存率 86 .2 % ;术后吞咽、呼吸功能恢复好 ,但有声音嘶哑。喉水平加垂直部分切除术后初期进食呛咳较重 ,训练适应时间较长 ,拔管率为82 .6 % ;5年生存率为 78.3% ;术后声音嘶哑 ,部分患者喉狭窄导致拔管困难。结论 :本方法操作简单 ,取材方便 ,手术时间较短 ,成活率高 ,术后喉功能保留好 ,患者的 5年生存率高。     

会厌喉成形术治疗喉声门型癌

目的探讨会厌喉成形术的可行性及手术方法。方法喉部分切除术后下移会厌瓣修复残存喉腔的前壁或侧前壁行喉成形术42例。结果患者术后喉功能恢复良好,总拔管率为92.9%,所有患者均于出院前拔除鼻饲管,发音可接受率为88.1%,3年、5年生存率分别为84.6%、77.1%。结论会厌瓣是喉部分切除喉成形术理想的修复材料之一。     

Complications of supraglottic laryngectomy for carcinomas of the supraglottis and the base of the tongue

The medical records of patients with either a supraglottic carcinoma (n = 193) or a base of tongue carcinoma (n = 56) who underwent a supraglottic laryngectomy were studied. Because of aspiration total laryngectomy was required in 9.8% and 21.4% of patients with supraglottic and base of tongue carcinomas, respectively, being related to locally advanced stage of disease in the base of tongue and to an age older than 65 years in the case of supraglottic carcinomas. The non-decannulation rates were 23.8% and 50% in supraglottic and base of tongue tumours respectively. Post-operative radiotherapy did not influence the decannulation rate. but advanced local disease and age did. Post-operative mortality in the first month after the operation was 2.6% in supraglottic tumours and 3.6% in base of tongue tumours.     

环状软骨上喉次全切除术及疗效分析

目的探讨环状软骨上喉次全切除术(简称环上喉次全切除术)的可行性及其疗效。方法回顾性分析1990—2001年43例行环上喉次全切除术的T1b～T4及术后放疗后复发的喉癌患者,声门上癌16例,声门癌21例,声门下癌2例;外院术后复发3例,放疗后复发1例。临床分级:T1b6例,T213例,T316例,T44例。应用3种不同的环上喉次全切除术进行治疗(17例行环上喉次全切除环舌骨固定术,24例行环上喉次全切除环舌骨会厌固定术,2例采用环上喉次全切除气管环舌骨会厌固定术)。16例患者辅以放疗。结果KaplanMeier法统计生存率,随诊中位时间57个月。全组总的3年累积生存率为90.7%,5年累积生存率83.7%。术后拔管率为95.3%(41/43)。保留双侧杓状软骨的拔管时间为14d,保留单侧杓状软骨的拔管时间为43d。术后8周评价误咽发生率为14.0%(6/43),切除会厌增加了术后的误咽及拔管时间(P<0.05)。结论环上喉次全切除术是一种在肿瘤根治和喉功能保全上能达到临床应用水平的术式。