跨声门癌扩大部分喉切除术重建方法与疗效评价

目的 探讨跨声门癌在保证根治肿的前提下恢复喉的发音、呼吸、吞咽防护功能。方法 对41例跨声门癌施行扩大部分喉切除术，包括扩大垂直喉切除术26例（25／41），扩大额侧喉切除术5例（5／41），次全喉切除术10例（10／41）。主要应用胸骨舌骨肌、颈阔肌双蒂转门肌皮瓣等同期进行缺损喉腔的重建。其中应用转门肌皮瓣修复27例，胸骨舌骨肌瓣修复7例，舌骨肌瓣修复5例，胸锁乳突肌和筋膜修复2例。结果 总的3年、5年生存率分别为85．7％（30／35）、74．1％（20／27），Ⅲ期患者3年、5年生存率分别为84．6％（22／26）、76．2％（16／21），Ⅳ期患者分别为3／4、1／2。总的气管套管拔出率为87．8％（36／41），应用颈前转门肌皮瓣修复组拔管率为96．3％（26／27），胸骨舌骨肌瓣为5／7，舌骨肌瓣为4／5，胸锁乳突肌瓣为1／2。全部患者恢复了发音功能，语音响应清晰者92．7％（38／41），吞咽防护功能全部恢复。结论 中、晚期跨声门癌选择性地施行功能保全性喉手术是可行性；应用转门肌皮瓣进行缺损喉腔重建可获得满意的喉功能恢复效果。

A clinical evaluation on reconstruction in extended partial laryngectomy for transglottic cancer]

OBJECTIVE: Transglottic cancer has been a definite indication for total laryngectomy in decades, compromising function of the larynx. The purpose of this study is to present a new radical surgery of extended partial laryngectomy and reconstruction to restore the essential function of larynx. METHODS: Forty-one cases of transglottic cancer were treated by extended vertical laryngectomy (26/41), extended frontolateral laryngectomy (5/41) and subtotal laryngectomy (10/41); the defects of larynx were reconstructed by rotary door myocutaneous flap in twenty-seven cases, by sternohyoideus flap in seven cases, by osteomuscular flap in five cases and by sternocleidomastoid flap in two cases. RESULTS: The 3 and 5 year survival rates were 85.7% (30/35) and 74.1% (20/27) respectively, those for stage III were 84.6% (22/26) and 76.2% (16/21), for stage IV were 3/4 and 1/2 respectively. All cases resumed acceptable voice, 92.7% (38/41) and enjoyed satisfactory phonation. The over-all decannulation rate was 87.8% (36/41), those with rotary door myocutaneous flap was 96.3% (26/27), with sternohyoideus flap was 5/7, with osteomuscular flap was 4/5 and with sternocleidomastoid flap was 1/2. All patients had normal swallow function. CONCLUSION: Extended partial laryngectomy is a kind of radical operation in selected cases of transglottic cancer. The method of reconstruction with rotary door myocutaneous flap can improve curative effect and the essential functions of the larynx.