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目的 :探讨肩胛舌骨肌瓣修复喉部分切除术后缺损的可行性和临床疗效。方法 :对 2 4例声门上型、声门型喉癌患者切除肿瘤和受累的软骨 ,以肩胛舌骨肌瓣修复组织缺损、重建声门。对于一侧杓状软骨固定患者 ,切除杓状软骨 ,在取肩胛舌骨肌瓣同时连带切取一小块舌骨 ,将小舌骨块固定于杓状软骨缺损处 ,用残余黏膜覆盖之。声门上型T2 、声门型T3 以上患者术后接受放射治疗 (5 0～ 6 0Gy)。结果 :随访 1～ 5年 ,1例声门上型(T3 )患者于术后 2年 9个月死于局部复发 ,1例声门型 (T3 )患者于术后 4年 3个月死于颈部转移和骨转移。拔管率为 95 .8%。 91.7%的患者发声近乎正常或声哑。吞咽功能全部恢复。结论 :经过仔细选择病例 ,肩胛舌骨肌瓣修复喉部分切除术后缺损、重建声门是积极有效和切实可行的。
Objective: To investigate the feasibility and clinical efficacy of scapular hyoid muscle flap for the repair of partial laryngectomy. Methods: Twenty - four cases of supraglottic glottic cancer were excised from the tumor and the involved cartilage. The scapular hyoid muscle flap was used to repair the tissue defect and the glottis was reconstructed. For patients with fixed arytenoid cartilage on one side, arytenoid cartilage is excised and a small hyoid bone is ligated along with the scapular musculocutaneous flap. The lesser sacral mass is fixed to the arytenoid cartilage defect and covered with residual mucosa. The supraglottic T2, glottic T3 patients received radiotherapy (50 ~ 60 Gy) after surgery. Results One to five patients with supraglottic (T3) patients died of local recurrence at 2 years and 9 months after operation, and one patient with glottis (T3) died at 4 years and 3 months after operation Neck metastases and bone metastases. Extubation rate was 95.8%. 91.7% of patients had almost normal or dumb sound. Swallowing full recovery. CONCLUSIONS: After careful selection of the cases and scapular hyoid muscle flap for the repair of laryngectomy and reconstruction of the glottis, it is both effective and practicable.