论文部分内容阅读
目的 使喉部分切除和扩大喉部分切除术后长期带管者去除气管套管 ,恢复喉的发音、呼吸、吞咽防护功能和正常颈部外观。方法 对 19例喉癌喉部分切除术后喉狭窄患者 ,应用颈前双蒂转门肌皮瓣等方法进行Ⅱ期喉重建术 ,其中包括垂直喉切除Ⅱ期喉重建术 6例 (6 / 19) ,扩大垂直喉切除术 11例 (11/ 19) ,额侧喉切除术 2例 (2 / 19)。应用颈前双蒂转门肌皮瓣修复 17例 ,胸骨舌骨肌瓣修复 1例 ,胸锁乳突肌和筋膜修复 1例。结果 3、5年生存率分别为 91 7% (11/ 12 )和 3/ 5。 19例中去除气管套管 16例 (其中包括 2例行 2次Ⅱ期喉重建术 )。总的气管套管拔出率为 84 2 % (16 / 19) ,应用转门肌皮瓣修复组拔管率为 94 1% (16 / 17) ,胸骨舌骨肌瓣和胸锁乳突肌瓣修复组均未能拔管 (0 / 2 ) ,拔管困难 3例。术后全部患者能够发音 ,语言交流无困难。其中语音响亮清晰者为 94 7% (18/ 19) ,重度声音嘶哑者为 5 3% (1/ 19)。全部患者恢复正常进食 ,绝大多数患者进食无误咽 ,2例初期进流食出现轻度误咽 ,1～ 2周误咽克服 ,恢复正常经口进食。结论 中、晚期喉癌选择性地施行功能保全性喉手术是可行的 ;应用转门肌皮瓣进行Ⅱ期喉重建术 ,可使喉部分切除术后长期带管者去除气管套管 ,重新获得经口鼻呼吸和满意的发?
Objective To remove the laryngectomy and expand the laryngectomy after long-term removal of the tracheal tube cannula to restore laryngeal sounds, breathing, swallowing protection and normal neck appearance. Methods Twenty-nine patients with throat stenosis after throat partial laryngectomy for laryngeal cancer were treated with the method of anterior cervical double-flap musculoskeletal flap reconstruction, including 6 cases of laryngeal reconstruction with vertical laryngectomy ), Enlarged vertical laryngectomy in 11 cases (11/19), and frontal laryngectomy in 2 cases (2/19). Seventeen cases were treated with anterior cervical double flap of musculocutaneous flap, one was repaired with sternal hyoid muscle flap, and one was treated by sternocleidomastoid muscle and fascia. Results The 3- and 5-year survival rates were 91.7% (11/12) and 3/5, respectively. In 19 cases, 16 cases of tracheal cannula were removed (including 2 cases of Ⅱ throat reconstruction in 2 cases). The total tracheal tube pull-out rate was 84 2% (16/19). The rate of extubation of the tracheal flap was 94 1% (16/17). The sternal hyoid muscle flap and sternocleidomastoid muscle Flap repair group failed to extubation (0/2), extubation in 3 cases. All patients can pronounce after surgery, language exchange without difficulty. Among them, 94.7% (18/19) of the speakers were loud and clear, and 53% (1/19) of those with severe hoarseness spoke loudly. All patients returned to normal eating, the vast majority of patients eating no error swallow, 2 cases of early into the stream of food appeared mild swallow, 1 to 2 weeks of swallowing to overcome the normal oral rehydration. Conclusions The selective laryngeal surgery of functional laryngeal carcinoma is feasible in the advanced laryngeal squamous cell carcinoma. The second stage laryngeal reconstructive surgery with the flap of the musculoskeletal flap allows the long-term laparoscopic removal of the tracheal tube after partial laryngectomy, Oral and nasal breathing and satisfied hair?