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目的:探讨环状软骨上喉部分切除环舌根会厌吻合术中保留一侧杓状软骨的手术方法及在改善患者术后发声的作用。方法:26例双声带受累的声门型喉癌(T1b、T2和T3分别为11、12和3例)病变重侧均行半喉全部切除,病变轻侧声带受累未超过膜部的2/3,离杓状软骨的声带突尚有3mm的安全界,在保留杓状软骨的同时保留该侧甲状软骨板后下1/3,以防喉返神经损伤,从而确保杓状软骨的正常运动。上提修复后的残喉体与舌根、会厌吻合,重建新喉。结果:全部病例术后7～23d内恢复正常饮食。25例拔除气管套管,拔管率为96.2%(25/26)。全部病例恢复了发声功能,术后有不同程度的声嘶,18例发声时有响声,能胜任室内言语交流,言语可被清楚理解;8例发声时响度较低,1m内近距离言语交流无障碍,在安静环境下言语可被清楚理解。术后无咽瘘和肺部并发症,2例局部感染者7d内治愈。术后局部复发率为3.8%(1/26),颈部淋巴结转移率为3.8%(1/26)。用直接法计算生存率,术后满3年者17例,死亡1例、失访1例,3年生存率为88.2%(15/17);术后满5年者10例,死亡2例,5年生存率为80.0%(8/10)。结论:经过选择的双声带受累病例,保留一侧杓状软骨有助于改善患者术后发声质量。杓状软骨主动的前内方向运动和会厌的相向运动可能是发声质量得以改善的原因。
OBJECTIVE: To investigate the surgical methods for preserving the unilateral arytenoid cartilage during the partial resection of ring-shaped cartilage laryngeal anastomosis and improve the sound of the patient after operation. Methods: Twenty - six cases of glottic glottic laryngeal cancer (T1b, T2 and T3 were 11, 12 and 3 cases, respectively) 3, from the arytenoid cartilage suddenly there is 3mm safety community, retaining the arytenoid cartilage while retaining the lateral thyroid cartilage after the next 1/3, in order to prevent recurrent laryngeal nerve injury, so as to ensure the normal arytenoid cartilage movement . After the restoration of the residual throat and tongue base, epiglottis anastomosis, reconstruction of the new throat. Results: All cases returned to normal diet within 7 ~ 23 days after operation. Twenty-five cases of tracheal tube were removed, and the rate of extubation was 96.2% (25/26). In all cases, the vocal function was restored. There were varying degrees of hoarseness after operation. There were loud sounds in 18 cases of vocalization, which could be used to communicate utterances clearly. The utterances of 8 cases were low, Obstacles, words in a quiet environment can be clearly understood. No postoperative pharyngeal fistula and pulmonary complications, 2 cases of local infection were cured within 7d. Postoperative local recurrence rate was 3.8% (1/26), cervical lymph node metastasis rate was 3.8% (1/26). Survival rate was calculated by direct method. Seventeen cases were found after 3 years of operation, 1 case died, 1 case was lost to follow-up, and 3-year survival rate was 88.2% (15/17). After 5 years of operation, 10 cases died and 2 cases died The 5-year survival rate was 80.0% (8/10). CONCLUSIONS: The retention of the arytenoid cartilage after selected dual vocal cord involvement helps to improve postoperative vocalization. Anterior and posterior inward movement of the arytenoid cartilage and epigranular movement may be the reason why the sound quality can be improved.