胸舌骨肌瓣或舌骨-胸舌骨肌瓣用于垂直喉部分切除术后声带重建

目的：探讨垂直喉部分切除术后改善发声，恢复喉功能的修复手段，以提高喉癌患者术后的生存质量。方法：垂直喉部分切除术后，用患侧甲状软骨外膜修复上半喉腔缺损，取健侧胸舌骨肌瓣（或舌骨－胸舌骨肌瓣）修复下半喉腔缺损并重建声带。结果：修复的新喉腔呈三角形，重建的声带具有一定的张力并参与发声，恰似一侧居于正中位麻痹的声带，发声时由健侧声带代偿运动与新声带前2／3相互靠近。93．4％的患者发声近乎正常或自觉发声质量较术前明显好转。结论：垂直喉部分切除术后采用患侧甲状软骨外膜和健侧胸舌骨肌瓣（或舌骨－胸舌骨肌瓣）修复缺损并重建声带，方法简单，取材方便，创伤小，效果满意，可作为垂直喉部分切除术后声带重建的首选方法。

A clinical study on improving phonation function of larynx after partial laryngectomy

OBJECTIVE: To analyse the clinical results of reconstruction of vocal cord using sternohyoid muscle flap after partial laryngectomy and research a new repairing method to improve laryngeal function and living quality of patient. METHOD: The pronunciation of larynx is on the basic of the vibration of the vocal cord by air current. The laryngeal appearance and the function of opposite side vocal cord is very important for improving the quality of pronunciation. We developed a technique of thyroid cartilage membrane and sternohyoid muscle flap to repair the defect left by a vertical laryngectomy and reconstructed the vocal cord. The thyroid cartilage membrane was used to bridge over the upper part defect of laryngeal cavity, the sternohyoid muscle flap forming the opposite side was made a 90 degree bent toward the laryngeal cavity to repaired the lower part defect of laryngeal cavity and reconstruct a new vocal cord. The repaired larynx recovered the normal appearance. The new vocal cord participated speech. The anterior 2/3 part of both vocal cored could contacted in pronunciation of patient. The phonation function of larynx was restored. RESULT: Sixty-one cases partial laryngectomy was taken including vertical partial laryngectomy in 37 cases, extended vertical partial laryngectomy in 24. During their operations, the laryngeal defect was repaired with thyroid cartilage membrane and sternohyoid muscle flap, and a vocal cord was reconstructed in the same time. After operation, the laryngeal cavity repaired has a normal appearance, and the laryngeal satisfactory phonation effect has been obtained. 93.4% of the patients enjoyed a socially acceptable voice and rejoined normal working. CONCLUSION: A technique of thyroid cartilage and sternohyoid muscle flap to repair the defect and reconstructive vocal cord after partial laryngectomy make patient recover normal laryngeal appearance and obtain satisfactory phonation effect. Among the method of repairation for partial laryngectomy sternohyoid muscle flap should be first considered owing to its various merits: 1. abundant material. 2. convenient procedures. 3. smaller trauma. 4. satisfactory effect.