喉癌喉部分切除及喉功能重建

目的对189例喉部分切除,喉功能重建的喉癌患者的临床资料进行回顾性分析,并对各种术式和修复方法的疗效进行评价。方法对189例喉癌患者喉部分切除术后,同期采用颈前带状肌肌筋膜瓣、会厌瓣加双蒂肌筋膜瓣和舌骨肌瓣修复喉组织缺损,重建喉功能。47例颈淋巴结转移者同期行颈廓清术。结果所有患者术后10～15d进食。术后拔除气管套管114例,拔管率60.3%。23例发生术后感染,7例发生咽瘘。3、5年生存率分别为72%和65.6%。有颈淋巴结转移者生存率低于无转移者,未接受放疗者生存率低于术后放疗者,差异均有统计学意义(P<0.05)。结论依据喉癌发生的部位和累及范围选择不同的术式和修复方法,同期喉功能重建提高了患者的生活质量,值得推荐。

Reconstruction of laryngeal function after partial laryngectomy for laryngeal carcinoma

Objective To investigate the effect of reconstruction of laryngeal function after partial laryngectomy in 189 patients suffering from laryngeal carcinoma. Methods Clinical data of 189 patients suffering from laryngeal carcinoma who recieved partial laryngectomy and reconstruction of laryngeal function from January 1986 to December 2000 were studied retrospectively. The laryngeal defects after partial laryngectomy were reconstructed with bi-pedicle muscle flap, epiglottic flap plus bi-pedicle muscle flap, or hyoid osteo-muscular flap. Among them, neck dissection was performed in 47 patients with cervical lymph node metastases. Results All the cases began to take food through mouth 10 to 15 days after operation. The decannulation rate was 60.3%. The wound infection occurred in 23 cases, and pharyngocutaneous fistulae in 7 cases. The 3 and 5 year survival rates were 72% and 65.6% respectively. The survival rates of patients with cervical lymph nodes metastases were lower than those without lymph nodes metastases; the survival rates of patients with postoperative radiotherapy were higher than those without postoperative radiotherapy. The differences were statistically significant. Conclusion The procedures of partial laryngectomy and reconstruction should be chosen according to the location of laryngeal carcinoma and extension involved. The corresponding reconstruction of laryngeal functions can improve the survival rate and quality of life of the patients. These procedures present ideal effects and are worthy to be recommended for advanced laryngeal carcinoma.