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目的 探讨跨声门癌在保证根治肿瘤的前提下恢复喉的发音、呼吸、吞咽防护功能。方法 对 41例跨声门癌施行扩大部分喉切除术 ,包括扩大垂直喉切除术 2 6例 (2 6 /41) ,扩大额侧喉切除术 5例 (5 /41) ,次全喉切除术 10例 (10 /41)。主要应用胸骨舌骨肌、颈阔肌双蒂转门肌皮瓣等同期进行缺损喉腔的重建。其中应用转门肌皮瓣修复 2 7例 ,胸骨舌骨肌瓣修复 7例 ,舌骨肌瓣修复 5例 ,胸锁乳突肌和筋膜修复 2例。结果 总的 3年、5年生存率分别为 85 .7% (30 /35 )、74.1% (2 0 /2 7) ,III期患者 3年、5年生存率分别为 84.6 % (2 2 /2 6 )、76 .2 % (16 /2 1) ,IV期患者分别为 3/4、1/2。总的气管套管拔出率为 87.8% (36 /41) ,应用颈前转门肌皮瓣修复组拔管率为 96 .3% (2 6 /2 7) ,胸骨舌骨肌瓣为5 /7,舌骨肌瓣为 4/5 ,胸锁乳突肌瓣为 1/2。全部患者恢复了发音功能 ,语音响亮清晰者 92 .7% (38/41) ,吞咽防护功能全部恢复。结论 中、晚期跨声门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缺损喉腔重建可获得满意的喉功能恢复效果
Objective To explore the transmenal cancer in the premise of radical cancer to restore the throat pronunciation, breathing, swallowing protective function. Methods A total of 41 cases of transnasal cancer were enrolled in this study. Some of them included enlarged laryngectomy (26 cases, 26/41), extended laryngectomy (5 cases), subtotal laryngectomy 10 cases (10/41). The main application of sternohyoid muscle, platysma double flap myopathy flap and other reconstructions of the missing throat during the same period. Among them, 27 cases were revascularized with myocutaneous flap, 7 cases with sternohyoid muscle flap repair, 5 cases with hyoid muscle flap repair, 2 cases with sternocleidomastoid and fascia repair. Results The overall 3-year and 5-year survival rates were 85.7% (30/35) and 74.1% (20/27) respectively. The 3-year and 5-year survival rates of patients in stage III were 84.6% (2 / 2 6), 76.2% (16/2 1), stage IV patients were 3 / 4,1 / 2. The total tracheal tube pull-out rate was 87.8% (36/41), and the rate of extubation was 96.3% (26/27) in the anterior cervical myocutaneous flap. The sternal hyoid muscle flap was 5 / 7, hyoid muscle flap is 4/5, sternocleidomastoid flap is 1/2. All patients recovered the pronunciation function, 92.7% (38/41) of loud and clear voice, swallowing protection fully restored. Conclusions It is feasible to perform functional preserving laryngectomy selectively in mid-late stage transglottic cancer. Satisfactory laryngeal function recovery effect can be obtained by using modified flap