喉癌喉部分切除术后喉狭窄Ⅱ期喉重建术临床评价

目的 使喉部分切除和扩大喉部分切除术后长期带管者去除气管套管，恢复喉的发音、呼吸、吞咽防护功能和正常颈部外观。方法 对19例喉癌喉部分切除术后切除术后喉狭窄患者，应用颈前双蒂转门肌皮瓣等方法进行Ⅱ期喉重建术，其中包括垂直喉切除Ⅱ期喉重建术6例（6/19）,扩大垂直喉切除术11例（11/19），额侧喉切除术2例（2/19）。应用颈前双蒂转门肌皮瓣修复17例，胸骨舌骨肌瓣修复1例，胸锁乳容肌和筋膜修复1例。结果 3、5年生存率分别为91.7%（11/12）和3/5。19例中去除气管套管16例（其中包括2例行2次Ⅱ期喉重建术）。总的气管套管拔出率为84.2%（16/19），应用转门肌皮瓣修复组拔管率为94.1%（16/17），胸骨舌骨肌瓣和胞锁乳突肌瓣修复组均未能拔管（0/2），拔管困难3例。术后全部患者能够发音，语言交流无困难。其中语音响亮清晰者为94.7%（18/19），重度声音嘶哑者为5.3%（1/19）。全部患者恢复正常进食，绝大多数患者进食无误咽，2例初期进流食出现轻度误咽，1-2周误咽克服，恢复正常经口进食。结论 中、晚期喉癌选择性地施行功能保全性喉手术是可行的；应用转门肌皮瓣进行Ⅱ期喉重建术，可使喉部分切除术后长期带管者去除气管套管，重新获得经口鼻呼吸和满意的发音、吞咽防护功能效果。

Clinical evaluation on second stage reconstruction for laryngostenosis after partial laryngectomy for laryngeal cancer patients]

OBJECTIVE: To present a new method of decannulation for laryngostenosis patients after partial laryngectomy and extended partial laryngectomy, and restoration of the essential functions of larynx and normal neck appearance. METHODS: Nineteen cases of laryngostenosis after partial laryngectomy and extended partial laryngectomy were treated with second stage reconstruction. The patients had been treated by vertical laryngectomy (6/19) using extended vertical laryngectomy (11/19) and frontolateral laryngectomy (2/19). Among these patients, second stage reconstruction of larynx was performed by using rotary door myocutaneous flap (17/19). Stemohyoideus flap (1/19) and sternocleidomastoid flap (1/19). RESULTS: Three and five year-survival rates were 91.7% (11/12) and 3/5, respectively. Over-all decannulation rate was 84.2% (16/19), but 94.1% (16/17) in patients with rotary door myocutaneous flap and 0% (0/2) in both patients with sternohyoideus flap and sternocleidomastoid flap. There were 3 decannulation failures (15.8%). All patients resumed acceptable voice, 94.7% (18/19) enjoyed satisfactory phonation, but 5.3% (1/19) showed severe hoarseness. All except 2 patients returned normal swallow function. The latter 2 patients experienced mild abnormal swallow during eating fluid food in early stage of surgery, but had normal swallow function after 1-2 weeks. CONCLUSION: Functional laryngectomy is a radical operation in selected cases with advanced laryngeal cancer. The second stage reconstruction with bi-pedical rotary door myocutaneous flaps can help decannulation in patients who developed laryngostenosis after partial laryngectomy and extended partial laryngectomy, and restore the essential function of larynx and normal neck appearance.