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侵犯舌根和邻近口咽壁的晚期表皮样癌,目前一般采用手术切除,加放疗,有时加化疗。改良声门上喉切除术,既能大块切除舌根和邻近咽壁肿瘤,又能保存喉的发声功能。方法如下: 局麻下作气管切开,然后全麻。从乳突尖到对侧乳突尖作一围裙样切口,于颈阔肌下掀起皮瓣,在舌骨下1cm处切断带状肌。沿甲状软骨上缘切开软骨膜,并予剥离。于甲状切迹下1/3水平切开软骨,,正好在前连合的假声带上方进入喉。如声门上或杓会厌皱襞未受侵犯,则可保留双侧假声带。此时沿肿瘤侵犯一侧的咽壁向上延长切口,横贯切除杓会厌皱襞、会厌、会厌前间
In cases of advanced epidermoid carcinoma that invade the tongue base and adjacent to the oropharyngeal wall, surgical resection, plus radiotherapy, and sometimes chemotherapy are commonly used. Improved supraglottic resection can both resecure the tongue base and adjacent pharyngeal wall tumors while preserving the vocal function of the larynx. The method is as follows: Tracheostomy under local anesthesia followed by general anesthesia. An apron-like incision was made from the tip of the mastoid to the contralateral mastoid tip. The flap was lifted under the platysma muscle and the band muscle was cut 1 cm below the hyoid bone. The perichondrium was cut along the upper edge of the thyroid cartilage and peeled off. The cartilage was cut at the lower 1/3 level of the thyroid notch, just above the anterior commissural false vocal cords. If the glottis or epiglottis folds are not infringed, the bilateral false vocal cords can be preserved. At this time, an incision is made along the pharyngeal wall on the side where the tumor invades, and the anterolateral fold, epiglottis, epiglottis, and epiglottis are traversed.