切除杓状软骨的喉垂直部分切除术中的残喉修复

目的探讨切除杓状软骨的喉垂直部分切除术残喉的修复方法。方法总结1991年1月—2000年12月87例(T1、12和，13分别有7、54和26例)声门型喉癌的疗效。因杓区或杓状软骨声带突受累，行切除杓状软骨的喉垂直部分切除术，术中利用局部组织修复残喉，重建喉功能。全部病例均未行填充物加高患侧杓区或利用皮瓣等其他组织重建声门。结果全部病例术后8～19d内恢复正常饮食。全部病例恢复了发音功能。86例患者拔除气管套管，拔管率为98，9％(86／87)。术后无咽瘘和肺部并发症，3例局部感染者7d内治愈。术后局部复发率为8，0％(7／87)，颈部淋巴结转移率为6．9％(6／87)。失访患者均按死亡计算，用直接法计算生存率，术后满3年者87例，3年内死亡5例、失访3例，3年生存率为90，8％(79／87)；术后满5年者63例，5年内死亡10例、失访2例，5年生存率为81．0％(51／63)。结论利用局部组织修复切除杓状软骨的喉垂直部分切除术的残喉，术后无严重误咽，发音效果良好，此修复方法既节约了手术时间，又避免了过度修复可能带来的负面影响。

Reconstruction of laryngeal defect in vertical partial laryngectomy with resection of arytenoid cartilage

Objective To discuss the method to reconstruct laryngeal defect after vertical partial laryngectomy with resection of arytenoid cartilage Methods Laryngeal defect was reconstructed with local tissues after vertical partial laryngectomy with resection of arytenoid cartilage on 87 patients with laryngeal carcinoma of glottic type (T1 7 cases, T2 54 cases, T3 26 cases) All the lesions invaded arytenoid area or vocal process No filling tissues were used to increase the height of affected arytenoid area and no skin flap or other tissues were used to reconstruct the vocal cord in all the patients Results All the patients recovered normal swallow in 8 to 19 days postoperation and restored phonation The decannulation rate was 98 9%(86/87) There were no pharyngeal fistula and pulmonary complications after operation Local infection occurred in 3 patients and was cured in 7 days The rate of local recurrence and cervical lymph node metastasis were 8 0%(7/87),6 9%(6/87) respectively Lost patients were assumed to death and direct method was used to calculate survival rate In 87 patients postoperative period was above 3 years, 5 died in 3 years and 3 were lost 3 year survival rate was 90 8%(79/87) In 63 patients postoperative period was above 5 years, 10 died in 5 years and 2 were lost 5 year survival rate was 81 0%(51/63) ConclusionsUtilizing local tissues to reconstruct laryngeal defect after vertical partial laryngectomy with resection of arytenoid cartilage will not lead to severe dysphagia Phonation is acceptable It not only saves the operation time but also avoids the negative effects of immoderate reparation