舌瓣在喉、喉咽部分切除重建中的作用

发布时间：2018-01-23 23:00

本文关键词： 舌瓣喉癌喉咽癌组织缺损组织修复　出处：《吉林大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：探讨舌瓣在喉癌、喉咽癌切除术后组织缺损修复中的作用。评价应用舌瓣修复喉癌、喉咽癌切除术后组织缺损，喉的呼吸、吞咽、发音三大功能的恢复，以提高喉癌、喉咽癌术后的治疗效果。方法：本研究采用回顾性研究的方法，收集吉大二院耳鼻咽喉科2004年1月至2011年12月应用各种舌根舌瓣行喉、喉咽癌切除术后组织缺损修复的病例31例患者临床资料进行分析，根据手术方式、病变部位、病理、有无颈部淋巴结转移，结合术后患者是否戴气管套管呼吸，进食是否有吞咽障碍及误吸，发音清晰度及声嘶程度为指标，评价应用舌瓣行术后组织缺损重建之后的呼吸、吞咽、发音三大功能恢复的情况，探讨修复方式与临床疗效的相关性。结果：本研究依据肿瘤的生长范围与扩散的程度，按照国际抗癌协会（UICC）TNM分类标准（2002）方案将31例患者进行临床分型，结果如下：26例为下咽癌梨状窝型，其中T_2N_0M_02例,T_2N_1M_07例,T_3N_0M_02例,T_3N_1M_07例,T_3N_2M_04例,T_4N_1M_02例,T_4N_2M_02例，2例为喉癌声门上型T_4N_1M_01例和T_3N_0M_01例，2例为喉癌声门型T_4N_2M_0，1例为喉癌复发。以上肿瘤病理类型均为鳞状细胞癌。本研究采用的舌瓣有三种：舌根全舌瓣27例，，其中4例应用胸骨舌骨肌筋膜联合舌瓣进行组织缺损的修复；舌根半舌瓣3例；蒂在一侧的横行舌根舌瓣1例。全部病人舌瓣成活，切口I期愈合；无吞咽障碍或经训练后恢复正常吞咽；除1例喉癌术后复发二次手术后语言交流有一定的障碍外，其余病人语言交流无明显障碍；5例拔除气管套管，5例现堵管呼吸。结论：舌瓣在喉、喉咽癌术后组织缺损修复中应用效果满意，依据喉、喉咽部组织缺损大小和部位设计不同的舌根舌瓣，其具有就近取材、组织损伤小、手术时间短、操作方便、血供丰富、成活率高、组织伸缩性大、并发症少等优点，是一种修复喉前壁、喉咽前壁及侧壁的确实可行的好方法，能显著提高喉及喉咽癌术后的治疗效果。
[Abstract]:Objective: To explore the role of tongue flap in the repair of tissue defect after laryngectomy for laryngeal carcinoma and laryngopharyngeal carcinoma. To evaluate the recovery of the three major functions of tongue flap in the repair of laryngeal carcinoma and the tissue defect after laryngopharyngectomy, and the respiratory, swallowing and pronunciation of the larynx. In order to improve the treatment of laryngocarcinoma and laryngopharyngeal carcinoma after operation. Methods: From January 2004 to December 2011, the Department of Otolaryngology of the second Hospital of Jilin University used all kinds of tongue root and tongue flap to perform larynx. The clinical data of 31 cases of resected tissue defect after laryngopharyngectomy were analyzed. According to the operation mode, pathological location and pathology, there was no cervical lymph node metastasis. According to whether the patients were breathing with trachea cannula, dysphagia and aspiration, articulation clarity and hoarseness degree, the patients were evaluated with tongue flap for breathing and swallowing after reconstruction of tissue defect after operation. The recovery of three major functions of pronunciation and the correlation between repair mode and clinical efficacy were discussed. Results: According to the range of tumor growth and the degree of tumor diffusion, 31 patients were classified according to the UICC TNM classification standard (2002) of the International Anticancer Association (IACA). The results are as follows: 26 cases of hypopharyngeal carcinoma are of the type of piriform nest of hypopharynx, of which Tsta2N0M02, T2N1M, 07 cases, T3N0M, 02 cases, T3N1Mtig, of which, 07 cases. Mr. 2 cases were glottic type of laryngeal carcinoma, 1 case was recurrence of laryngeal carcinoma. All the tumors were squamous cell carcinoma. There were three kinds of tongue flap in this study: 27 cases of tongue root total tongue flap. Among them, 4 cases were repaired with sternohyoid muscle fascia combined with tongue flap. Tongue root half tongue flap 3 cases; 1 case of lateral tongue root flap with pedicle. All patients survived the flap and the incision healed in I stage. No dysphagia or normal swallowing after training; Except for one patient with recurrent laryngeal cancer, there was no obvious disturbance in language communication after secondary operation. Tracheal cannula was removed in 5 cases. Conclusion: Tongue flap was applied to repair the tissue defect of larynx and laryngopharyngeal carcinoma. According to the size and position of larynx and pharynx tissue defect different tongue root tongue flap was designed. The operation time is short, the operation is convenient, the blood supply is abundant, the survival rate is high, the tissue scalability is big, the complication is few and so on the merit, is one kind of repair larynx anterior wall, larynx anterior wall and the side wall actually feasible good method. It can significantly improve the treatment effect of larynx and laryngopharyngeal carcinoma after operation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R766.9

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