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目的 探讨切除杓状软骨的喉垂直部分切除术残喉的修复方法。方法 总结 1991年 1月— 2 0 0 0年 12月 87例 (T1、T2和T3分别有 7、5 4和 2 6例 )声门型喉癌的疗效。因杓区或杓状软骨声带突受累 ,行切除杓状软骨的喉垂直部分切除术 ,术中利用局部组织修复残喉 ,重建喉功能。全部病例均未行填充物加高患侧杓区或利用皮瓣等其他组织重建声门。结果 全部病例术后 8～ 19d内恢复正常饮食。全部病例恢复了发音功能。 86例患者拔除气管套管 ,拔管率为 98 9% (86 / 87)。术后无咽瘘和肺部并发症 ,3例局部感染者 7d内治愈。术后局部复发率为 8 0 % (7/ 87) ,颈部淋巴结转移率为 6 9% (6 / 87)。失访患者均按死亡计算 ,用直接法计算生存率 ,术后满 3年者 87例 ,3年内死亡 5例、失访 3例 ,3年生存率为 90 8% (79/ 87) ;术后满 5年者 6 3例 ,5年内死亡 10例、失访 2例 ,5年生存率为 81 0 % (5 1/ 6 3)。结论 利用局部组织修复切除杓状软骨的喉垂直部分切除术的残喉 ,术后无严重误咽 ,发音效果良好 ,此修复方法既节约了手术时间 ,又避免了过度修复可能带来的负面影响
Objective To investigate the method of repairing the residual throat of the laryngectomy with removal of the arytenoid cartilage. Methods The clinical data of 87 patients with glottic laryngeal carcinoma (T1, T2 and T3, respectively, 7, 54 and 26 cases) from Jan 1991 to Dec 2000 were summarized. Due to dipper or arytenoid cartilage bumpy involvement, removal of arytenoid vertical partial laryngectomy surgery, intraoperative use of local tissue repair residual throat, reconstruction of laryngeal function. In all cases, filling was not performed to increase the affected side of the scoop area or flap and other organizations to rebuild the glottis. Results All patients returned to normal diet within 8 ~ 19 days after operation. All cases recovered the pronunciation function. In 86 patients, the tracheal tube was removed and the rate of extubation was 98 9% (86/87). No postoperative pharyngeal fistula and pulmonary complications, 3 cases of local infection were cured within 7d. The local recurrence rate was 80% (7/87) and the rate of cervical lymph node metastasis was 69% (6/87). The patients who lost their follow-up were calculated according to the death rate. The survival rate was calculated by direct method. 87 patients were 3 years after operation, 5 patients died within 3 years, 3 patients were lost to follow-up, and the 3-year survival rate was 90.8% (79/87) There were 63 cases after 5 years, 10 cases died within 5 years, 2 cases lost to follow-up, and the 5-year survival rate was 81 0% (51/6 3). Conclusion Local tissue repair of the residual laryngeal laryngectomy for the removal of the arytenoid cartilage by vertical partial laryngectomy with no serious postoperative pharyngeal pharyngeal obstruction and good vocalization results in this method of repair not only saving operation time but also avoiding possible negative effects of over-repair