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瘤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（26/41），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，语音响亮清晰者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的；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.