论文部分内容阅读
目的采用声门区形态学参数以及嗓音参数客观评价室带下拉联合颈部带状肌肌筋膜瓣修复早期声门型喉癌术后喉腔缺损的疗效。方法 2008年1月-2012年12月,收治47例早期声门型喉癌男性患者。年龄60~75岁,平均68.5岁。病程4~11个月,平均7.2个月。根据美国癌症联合会(AJCC)TNM分期标准,T1aN0M0期28例,T1bN0M0期14例,T2N0M0期5例;均累及前联合。喉部分切除术后,采用室带下拉联合带状肌肌筋膜瓣修复喉腔缺损。术前1 d及术后1年,应用螺旋CT扫描喉部声门区,测量喉部声带突平面的声门区前后径、两侧声带突间距离(简称声突间距)及声门区软组织厚度,评价联合软组织瓣对喉结构重建后形态的影响;检测嗓音参数基频(F0)、基频微扰(Jitter)、振幅微扰(Shimmer)、声门噪声能量(normalized noise energy,NNE)及最长声时(maximum phonatory time,MPT),评价联合软组织瓣参与喉发音的效果。结果术后病理检查示,38例为高分化鳞状细胞癌,9例为中分化鳞状细胞癌;切缘均未发现肿瘤。术后7~9 d颈部切口愈合;44例于术后9~11 d拔除气管套管,3例于3周拔除气管套管。47例患者均在术后3~4 d顺利经口进食。患者均获1年随访。术后1年,患者声门区前后径较术前1 d显著减小(t=15.161,P=0.000),声突间距及声门区软组织厚度手术前后比较差异均无统计学意义(P>0.05)。术后1年患者Shimmer、NNE及MPT与术前1 d比较差异有统计学意义(P<0.05),F0及Jitter与术前1 d比较差异无统计学意义(P>0.05)。结论室带下拉联合带状肌肌筋膜瓣可有效修复喉部分切除后的喉腔缺损,维持术后有效气道的建立;其不仅对喉形态无显著影响,还可作为新喉的有效发声振动体。
Objective To objectively evaluate the curative effect of ventricular pull-off combined with cervical myofascial fasciocutaneous flap for the repair of laryngeal cavity defect of early glottic laryngeal cancer by using glottis morphological parameters and voice parameters. Methods From January 2008 to December 2012, 47 male patients with early glottic cancer were treated. Age 60 to 75 years, mean 68.5 years old. Duration of 4 to 11 months, an average of 7.2 months. According to the TNM staging criteria of the American Cancer Society (AJCC), there were 28 cases of T1aN0M0 stage, 14 cases of T1bN0M0 stage and 5 cases of T2N0M0 stage. After the partial laryngectomy, the use of ventricular band pull combined with myofascial flap to repair laryngeal defects. On the first day before operation and one year after operation, the throat glottic area was scanned by spiral CT, and the anteroposterior diameter of the glottis area, the distance between the vocal cords and the soft tissue in the glottis area (F0), Jitter, Shimmer, normalized noise energy (NNE) were measured to evaluate the effect of combined soft tissue flap on the morphology of laryngeal reconstruction. And maximum phonatory time (MPT) to evaluate the effect of joint soft tissue flap on laryngeal sounds. Results Postoperative pathological examination revealed 38 cases of well-differentiated squamous cell carcinoma and 9 cases of moderately differentiated squamous cell carcinoma. No tumor was found on the margin. Neck incision healed 7 days to 9 days after operation. In 44 cases, tracheal cannula was removed 9 to 11 days after operation, and tracheal cannula was removed in 3 cases at 3 weeks. 47 patients were successfully oral intake of 3 ~ 4 d after surgery. Patients were followed up for 1 year. One year after operation, the anteroposterior diameter of the glottis area was significantly decreased compared with that at 1 d before surgery (t = 15.161, P = 0.000). There was no significant difference in the distance between the acoustic processes and the soft tissue thickness of the glottis before and after operation (P> 0.05). The Shimmer, NNE and MPT at 1 year after operation were significantly different from those at 1 day before operation (P <0.05). There was no significant difference between F0 and Jitter at 1 day before operation (P> 0.05). Conclusion The combination of band-pull and band-muscle myofascial flap can effectively repair laryngeal defects after partial laryngectomy and maintain the effective airway after operation. It not only has no significant effect on laryngeal morphology, but also can be used as an effective voice of new larynx Vibrating body.