晚期喉癌喉部分切除喉功能重建的疗效评价

目的探讨晚期喉癌行喉部分切除喉功能重建的可行性及方法。方法选择28例B、T4期声门上型及声门型喉癌行垂直半喉切除术（3例）、垂直侧前位喉部分切除（15例）、水平垂直部分喉切除术（10例），重建材料采用舌骨肌瓣7例、改良会厌瓣9例、胸骨舌骨肌软骨膜瓣11例，胸锁乳突肌瓣1例。结果随访3～5年，3年存活率82．1％（23／28）、5年存活率61．9％（13／21），气管套管拔除率67．9％（19／28），发音清晰、响亮占64．3％（18／28），2例出现咽瘘，换药后4-6周愈合，所有病例吞咽保护功能均完全恢复。结论晚期喉癌选择性施行喉功能保全性手术是可行的，根据肿瘤部位采用适当术式，利用各种组织瓣进行喉功能重建能明显提高生活质量。

Evaluation of effect of laryngeal function reconstruction after partial laryngectomy for advanced laryngocarcinoma

Objective To investigate the feasibility and method of laryngeal function reconstruction after partial laryngectomy for advanced laryngocarcinoma. Methods In totally 28 selected T3-T4 patients with supraglottic or glottic laryngocarcinoma, subtotal laryngectomy with vertical latero-anteposition was performed in 15 cases, horizon-vertical partial laryngcctomy was performed in 10 cases and vertical partial laryngectomy was performed in 3 cases. Materials for laryngeal function reconstruction included hyoid muscular flap （7 cases） , modified epiglottis flap （9 cases）, sternohyoid muscle perichondrium flap （11 cases） and sternocleidomastoid muscle flap （1 case）. Results All cases were followed up for 3 to 5 years, with 3 year survival rate of 82.1% （23/28） and 5 year survival rate of 51.9% （ 13/21 ）. 67.9% （ 19/28 ） of tracheal cannula were pulled out, the voiced functions were completely recovered in 64. 3 % （18/28） of the patients. Pharyngeal fistula occurred in 2 cases and healed within 4-6 weeks. The swallowing protection functions were completely recovered in all cases. Conclusion Larynx function reserved operation was feasible for selected advanced laryngocarcinoma. Reconstruction applying various flaps according to sites of the lesion could improve the quality of life significantly.