异种脱细胞真皮基质修复膜修复喉黏膜缺损的临床动态观察

目的 探讨应用异种(牛)脱细胞真皮基质修复膜修复喉肿瘤手术后黏膜缺损的临床使用价值.方法 对18例声门区喉癌患者切除后应用异种(牛)脱细胞真皮基质修复膜进行一期修复,有单纯修复膜修复和修复膜与肌瓣或肌筋膜瓣联合修复两种方法 .其中T2NOM0 8例.T3N1M05例,T3N2M0 4例,T4N2M0 1例.病理类型均为鳞状细胞癌.手术后10例患者进行了放射治疗,放疗剂量为60～80 Gy.手术后半年内连续进行电子纤维喉镜检查4～5次,观察修复膜的动态变化情况.结果 18例患者喉部黏膜缺损处均1期愈合,未发现过敏和排斥反应.术后0.5至6个月的电子喉镜检查发现,修复膜修复处在30～60 d逐渐被黏膜修复,喉的呼吸、发音、吞咽三大功能恢复.18例患者1年内均生存;治疗满2年的12例患者中10例无瘤生存,2例死亡.10例术后放疗患者喉黏膜恢复过程未受到影响.结论异种(牛)脱细胞真皮基质修复膜修复喉肿瘤术后的黏膜缺损手术操作简便,有很好的临床应用价值.

Dynamic observation of applying repairing laryngeal mucosal defect with heterogenous acellular dermal matrix

Objective To study the clinical effect of heterogeneity (cattle) acellulur deunal matrix in repairing mucosa defect in laryngeal surgery. Methods Eighteen cancer patients with mucosa defect in central vocal area accepted treatment with heterogeneity acellular deunal matrix after surgery. There were two methods to repair mucosa defect. One was simple use of acellular deunal matrix, the second was combined use of acellular deunal matrix and muscle lamella or muscle and tendon film lameUa. 18 cases had cancer in central vocal area: T2N0M0(8), T3N1M0(5), T3N2M0(4), T4N2M0(1). All were squamous cell carcinoma. Ten cancer patients accepted radiation after surgery. The radiotherapy volume was 60 -80 Cry. After the operation, the patients were checked by fibrolaryngoscope four or five times after half a year, observing the dynamic development. Results All 18 patients were healed, rechecked by endoscope after 0. 5 -6 months, heterogeneity acellular deunal matrix mingled with mucosa within 30 -60 d, no allergy and irritation were found. The laryngeal function, including breathing, pronouncing and swallowing, was recovered. The survival rate (1 year) was 100%, and 10 patients survived after 2 years. After radiotherapy, the process of recovery was not affected. Conclusions Heterogeneity acellular deual matrix can be easily obtained and it is a new method to repair mucosa defect. The operative procedure is easy to perform and worthwhile to use clinically.