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目的:探讨咽侧径路水平喉部分切除手术的技术操作、疗效及该径路积极的临床意义。方法:收集2000-2008年间咽侧径路水平喉部分切除术19例患者的临床资料,11例声门上型,8例下咽上型(其中1例侵犯舌体,2例侵犯舌根扁桃体软腭,2例侵犯下咽侧后壁);其中术中采用直接缝合12例,甲状软骨膜3例,胸锁乳突肌肌皮瓣1例,胸大肌肌肌皮瓣修复3例。术后根据需要给予放射治疗。结果:19例患者全部拔出气管套管,16例一期拔管,拔管后呼吸通畅;发声良好,无1例发生咽瘘;1例术后6个月仍有轻度误吸,1例术后1年突然咽部大出血死亡,2例术后颈总动脉转移出血死亡,4例术后2年内复发,3例3~5年内复发;3年生存率78.9%,5年生存率57.9%。结论:咽侧径路水平喉部分切除术损伤相对小,功能恢复快,为较好的手术方式。
Objective: To investigate the technical operation and curative effect of horizontal partial laryngectomy for pharyngeal approach and its positive clinical significance. Methods: The clinical data of 19 patients with pharyngeal pathological horizontal partial laryngectomy during 2000-2008 were collected, 11 cases of supraglottic and 8 cases of hypopharyngeal type (including 1 invaded the tongue, 2 invaded the soft palate in the tongue base, 2 cases of invasion of the posterior wall of the hypopharynx). Among them, 12 cases were directly sutured, 3 cases were thyroid cartilage, 1 case was sternocleidomastoid myocutaneous flap and 3 cases were pectoralis major myocutaneous flap. Postoperative radiotherapy as needed. Results: Twenty-nine patients had all the tracheal cannulas removed, and 16 patients had extubation in the first stage. The extubation was successful after extubation. The vocalizations were good, no pharyngolaryngeal fistula occurred in one case, and mild aspiration was observed in one case at 6 months One patient died of pharyngeal hemorrhage one year after operation. Two patients died of common carotid artery hemorrhage after operation. Four patients relapsed within 2 years after surgery and 3 patients relapsed within 3 to 5 years. The 3-year survival rate was 78.9% and the 5-year survival rate was 57.9 %. Conclusion: The pharyngeal approach horizontal throat resection injury is relatively small, fast recovery, a better surgical approach.