不同咽喉入路方式在声门上型喉癌手术中的应用

目的分析声门上型喉癌保留喉功能手术中进入咽喉腔的合理入路。方法对21例行声门上喉部分切除术的患者分别采用会厌谷入路、声带前连合上方入路及咽侧入路进入咽喉腔,完整切除肿瘤并行相应修复方式,保留喉功能。结果所有患者手术顺利,术中进入咽喉腔及肿瘤切除的过程中符合肿瘤切除的"无瘤"原则,术后病理未出现手术切缘阳性,无咽瘘。全部患者均于术后10～30 d拔除鼻饲管经口进食,20例患者于术后14～60 d拔除气管套管,所有患者均发音成功。结论声门上型喉癌行保留喉功能手术时,根据肿瘤原发部位及局部浸润情况,采取不同入路进入咽喉腔既获得了满意的手术视野及疗效,同时遵循了肿瘤切除的"无瘤"原则。

Different surgical approaches in supraglottic horizontal laryngectomy

OBJECTIVE To evaluate different surgical approaches in supraglottic horizontal laryngectomy.METHODS Twenty one cases of supraglottic squamous cell carcinomas underwent the supraglottic horizontal laryngectomy via different surgical approaches such as vallecula epiglottica,supra-anteriorcommisure and lateral wall of larynx.All the tumors were totally removed with negative cutting edge and the laryngeal cavities were repaired instantly.RESULTS All the operations were smooth and none of the patients got pharyngeal fistula after operation.The nasogastric feeding tubes were kept about 10～30 days.All the cases had ideal phonation after operation and twenty of them had the tracheal tube pulled out.CONCLUSION Different surgical approaches could be used in supraglottic horizontal laryngectomy according to the tumor＇s location and biological character.Thus they could provide well surgical exposure and abide by the principal of ＇No Tumor＇.