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背景:喉部分切除后的功能重建,传统方法多使用胸骨舌骨肌瓣等作修复材料,但远期效果不理想。目的:探讨用甲状软骨外层黏骨膜瓣修复创面并重建发声功能的效果。设计:以患者为研究对象,前后对照观察性研究。单位:一所市级医院耳鼻咽喉科。对象:选择1998-06/2004-05汕头市第二人民医院耳鼻咽喉科收治喉癌患者57例,男56例,女1例;年龄37～78岁,平均60.38岁;病程2个月～1年,平均约5个月。方法:对57例喉癌患者,保留患侧甲状软骨外层黏骨膜瓣,向内翻入至喉腔,以覆盖创面,并重建声带。主要观察指标:终点结局指标:治疗前后症状和功能变化及卡氏评分。危险性指标:不良事件和副反应。结果:57例手术均取得成功,治疗前呼吸道梗阻、声音嘶哑发生率分别为38.9%和98.1%,治疗后分别为1.9%和96.3%,卡氏评分治疗前、后分别为40和70分。未出现近、远期喉狭窄等并发症。结论:垂直半喉切除黏骨膜瓣喉重建术操作较容易,创面覆盖好,发声效果满意,对呼吸功能无影响,并发症发生率低,远期效果理想。
Background: Functional reconstruction after laryngectomy has been performed. Traditionally, the sternal hyoid muscle flap is used as a repair material, but the long-term effect is not satisfactory. Objective: To investigate the effect of repairing the wound surface and reconstructing vocal function with the outer thyroid mucoperiosteal flap. Design: Patients as the research object, before and after contrast observational studies. Unit: a municipal hospital otolaryngology. PARTICIPANTS: Fifty-seven patients with laryngeal cancer admitted to Department of Otorhinolaryngology, Second People’s Hospital of Shantou from June 1998 to May 2004 were enrolled, 56 males and 1 females, aged from 37 to 78 years (mean 60.38 years). The course of disease ranged from 2 months to 1 Year, an average of about 5 months. Methods: 57 cases of laryngeal cancer patients, retaining the ipsilateral thyroid cartilage outer mucoperiosteal flap into the larynx to cover the wound, and reconstruction of the vocal cords. MAIN OUTCOME MEASURES: End-point outcome measures: Changes in symptoms and function before and after treatment and Karnofsky scores. Hazard indicators: adverse events and side effects. Results: All the 57 surgeries were successful. The incidences of respiratory obstruction and hoarseness before treatment were 38.9% and 98.1%, respectively, and 1.9 and 96.3% after treatment respectively. The Karnofsky scores were 40 and 70 before and after treatment respectively. No recent, long-term complications such as laryngeal stenosis. CONCLUSION: The operation of laryngeal reconstruction of mucoperiosteal flap with vertical and semi-laryngectomy is easy, the coverage of the wound is good, the vocalization is satisfactory, the respiratory function is not affected, the complication rate is low and the long-term effect is satisfactory.