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目的 :探讨喉次全切除术后创面修复及喉功能的重建。方法 :对 33例喉癌患者行喉次全切除术。手术范围 :切除舌骨 ,大部分甲状软骨板 ,会厌前间隙和声带、室带 ,保留一侧杓状软骨及一侧 1/ 3甲状软骨板、1/ 3的声带。采用一侧的带蒂皮瓣、对侧带蒂的肌膜瓣修复创面和喉功能重建。结果 :全部患者均恢复正常的呼吸、吞咽功能 ,93.9%拔除气管套管获得发声功能。随访 2～ 5年 ,3例死于肿瘤以外的疾病 ,2例死于肿瘤多脏器转移。结论 :喉次全切除术后 ,应用带蒂皮瓣和肌膜瓣修复创面 ,重建发声功能 ,具有取材方便、血运好、不易造成喉狭窄、缩短带管时间以及提高患者生存质量等优点。
Objective: To investigate the repair of wounds and reconstruction of laryngeal function after total subtotal laryngectomy. Methods: 33 cases of laryngeal cancer patients underwent subtotal laryngectomy. Surgical range: removal of the hyoid bone, most of the thyroid cartilage plate, epiglottic space and vocal cord, ventricular zone, retaining the side of the arytenoid cartilage and side of the 1/3 thyroid cartilage, 1/3 vocal cords. One side of the pedicle flap was used to repair the wound and laryngeal reconstruction with contralateral pedicled sarcolemma flap. Results: All patients were resumed normal breathing, swallowing function, 93.9% removal of tracheal tube to obtain vocal function. Follow-up 2 to 5 years, 3 patients died of diseases other than cancer, 2 patients died of multiple organ metastases. Conclusion: After total subtotal laryngectomy, the pedicle flap and sarcoplasmic flap are used to repair the wound and rebuild the vocal function. It has many advantages such as convenient drawing, good blood supply, less stenosis, shortening the time of laparotomy and improving the life quality of patients.