联合软组织瓣修复喉癌术后缺损疗效的客观评价

发布时间：2018-10-05 13:18

【摘要】：目的采用声门区形态学参数以及嗓音参数客观评价室带下拉联合颈部带状肌肌筋膜瓣修复早期声门型喉癌术后喉腔缺损的疗效。方法 2008年1月-2012年12月,收治47例早期声门型喉癌男性患者。年龄60~75岁,平均68.5岁。病程4~11个月,平均7.2个月。根据美国癌症联合会(AJCC)TNM分期标准,T1aN0M0期28例,T1bN0M0期14例,T2N0M0期5例;均累及前联合。喉部分切除术后,采用室带下拉联合带状肌肌筋膜瓣修复喉腔缺损。术前1 d及术后1年,应用螺旋CT扫描喉部声门区,测量喉部声带突平面的声门区前后径、两侧声带突间距离(简称声突间距)及声门区软组织厚度,评价联合软组织瓣对喉结构重建后形态的影响;检测嗓音参数基频(F0)、基频微扰(Jitter)、振幅微扰(Shimmer)、声门噪声能量(normalized noise energy,NNE)及最长声时(maximum phonatory time,MPT),评价联合软组织瓣参与喉发音的效果。结果术后病理检查示,38例为高分化鳞状细胞癌,9例为中分化鳞状细胞癌;切缘均未发现肿瘤。术后7~9 d颈部切口愈合;44例于术后9~11 d拔除气管套管,3例于3周拔除气管套管。47例患者均在术后3~4 d顺利经口进食。患者均获1年随访。术后1年,患者声门区前后径较术前1 d显著减小(t=15.161,P=0.000),声突间距及声门区软组织厚度手术前后比较差异均无统计学意义(P0.05)。术后1年患者Shimmer、NNE及MPT与术前1 d比较差异有统计学意义(P0.05),F0及Jitter与术前1 d比较差异无统计学意义(P0.05)。结论室带下拉联合带状肌肌筋膜瓣可有效修复喉部分切除后的喉腔缺损,维持术后有效气道的建立;其不仅对喉形态无显著影响,还可作为新喉的有效发声振动体。
[Abstract]:Objective to evaluate the effect of ventricular band pull-down combined with cervical band myofascial flap in the repair of laryngeal cavity defect after early glottic laryngeal carcinoma by glottic area morphological parameters and voice parameters. Methods from January 2008 to December 2012, 47 male patients with early glottic laryngeal carcinoma were treated. The average age was 68.5 years. The course of disease ranged from 4 to 11 months with an average of 7.2 months. According to the (AJCC) TNM staging criteria of American Cancer Federation, 28 cases of T1a N0M0 stage T1bN0M0 14 cases of T1bN0M0 stage T2N0M0 were all involved in anterior union. After partial laryngectomy, the defect of laryngeal cavity was repaired by using ventricular band pull-down and band myofascial flap. The glottic area was scanned by spiral CT 1 day before operation and 1 year after operation. The anterior and posterior diameter of the glottic area, the distance between the vocal processes and the soft tissue thickness of the glottic region were measured. To evaluate the effect of combined soft tissue flap on laryngeal structure reconstruction, to detect the fundamental frequency (F0) of voice parameters, the amplitude perturbation (Shimmer), glottic energy (normalized noise energy,NNE) and the longest sound time (maximum phonatory time,MPT) of (Jitter), and to evaluate the effect of the combined soft tissue flap on larynx pronunciation. Results the pathological examination showed that 38 cases were well differentiated squamous cell carcinoma 9 cases were moderately differentiated squamous cell carcinoma and no tumor was found in the incisal margin. 44 patients with cervical incision healing were removed trachea cannula at 9 and 11 days after operation. All the 47 patients took out trachea cannula at 3 weeks and took food through mouth at 3 and 4 days after operation. All patients were followed up for 1 year. 1 year after operation, the anterior and posterior diameter of glottic area was significantly decreased (t 15.161 P0. 000). There was no significant difference in the distance between vocal process and the thickness of soft tissue in glottic area before and after operation (P0.05). There was no significant difference in Shimmer,NNE and MPT between one day and one day after operation (P0.05). There was no significant difference in F0 and Jitter between one day and one day after operation (P0.05). Conclusion Ventricular band pull-down combined with band myofascial flap can effectively repair the laryngeal cavity defect after partial laryngectomy and maintain the establishment of effective airway after laryngectomy, which not only has no significant effect on the laryngeal morphology, but also can be used as an effective vocal vibration body for the new larynx.
【作者单位】：淄博市中心医院耳鼻咽喉头颈外科;
【分类号】：R739.65

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