论文部分内容阅读
目的:探讨梨状窝癌喉下咽切除术后应用残喉瓣修补下咽缺损的可行性。方法:应用残喉瓣修补梨状窝癌喉下咽切除术后下咽缺损7例。术中切除患侧半咽和半喉,保留健侧半喉,剔除甲状软骨、环状软骨及杓状软骨,将软骨内膜保留于喉瓣上,形成一个与健侧舌根有宽广基蒂的大小约4.0cm×2.0cm的喉瓣,术中保留健侧的舌骨下肌群,勿损伤健侧喉上动脉。下拉舌根与咽侧壁上方切缘缝合,喉瓣切缘与下咽后壁及食管入口上方切缘缝合。术后均行放疗,剂量为60Gy。结果:术后6例患者一期愈合;1例患者出现局部感染和咽瘘,经局部换药2周内愈合。全部患者吞咽功能良好。7例术后随访3~5年,3年内死亡3例,4年内死亡1例。结论:对于适合的梨状窝癌患者,应用残喉黏膜瓣修补下咽缺损具有操作简单,安全可靠,损伤小,并发症少的优点。
Objective: To investigate the feasibility of repairing hypopharyngeal defects by using the residual laryngeal flap after laryngectomy for pear-shaped fossa cancer. Methods: 7 cases of hypopharyngeal defect after throatopharyngectomy were treated with residual throat flap. Intraoperative resection of the affected side of the half pharynx and half laryngeal, retaining the contralateral half throat, remove the thyroid cartilage, cricoid cartilage and arytenoid, the cartilage retained in the laryngeal valve to form a broad base with the contralateral tongue base size about 4.0cm × 2.0cm of the laryngeal flap, during surgery to retain the hyoid side of the hyoid muscle, do not damage the contralateral laryngeal artery. Pull down the tongue and the pharyngeal side of the wall above the suture edge, laryngeal cut edge and hypopharyngeal wall and esophageal incision above the suture edge. Postoperative radiotherapy, the dose of 60Gy. Results: Six cases were cured in one stage after operation. One case developed local infection and pharyngeal fistula and healed within 2 weeks after local dressing. All patients swallow well. Seven cases were followed up for 3 to 5 years, 3 died within 3 years and 1 died within 4 years. CONCLUSIONS: For the suitable patients with pear-shaped fossa cancer, the application of the residual laryngeal mucosal flap to repair hypopharyngeal defects has the advantages of simple operation, safe and reliable, less damage and fewer complications.