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目的:探讨喉部分切除术中单侧杓状软骨切除的残喉修复的手术方式。方法:总结我院2002-2006年17例行单侧杓状软骨切除的喉癌(声门型12例,声门上型5例),术中利用局部组织修复、双蒂胸骨舌骨肌筋膜瓣、自体游离甲状软骨、舌骨肌瓣等方法修复残喉,重建喉功能。结果:全部病例术后7～52d内恢复正常饮食,全部病例恢复了发音功能,1例患者行显微喉镜下CO2激光切除,未行气管切开,14例患者拔除气管套管,1例声门上型喉癌行舌骨肌瓣修复的患者能长期耐受堵管,但未拔管,1例声门型喉癌因喉狭窄未拔管。结论:喉部分切除术中单侧杓状软骨切除的残喉修复可根据术中情况采用不同方法修复,对于声门型喉癌行喉垂直切除术的患者,采用局部组织修复、双蒂胸骨舌骨肌筋膜瓣的方法,术后吞咽功能恢复均较为满意,对于声门型喉癌行环状软骨-舌骨-会厌固定术的患者或声门上型喉癌行喉部分切除术的患者,采用加高杓区的修复残喉的方法可减少误咽,自体游离甲状软骨修复是较为简便有效的方法。
Objective: To investigate the surgical approach for the treatment of residual sphincter of unilateral arytenoid cartilage resection in partial laryngectomy. Methods: A total of 17 cases of laryngeal carcinoma with unilateral arytenoid cartilage resection in our hospital from 2002 to 2006 (12 cases of glottis type and 5 cases of glottis type) were treated with local tissue repair, Membrane, autologous free thyroid cartilage, hyoid muscle flap and other methods to repair the residual throat, reconstruction of laryngeal function. Results: All the patients returned to normal diet within 7 ~ 52 days after operation, all patients recovered their phonetic function, one underwent CO2 laser micronephroscopy without tracheotomy, and 14 patients with tracheal cannula were removed. One patient Patients with supraglottic laryngeal cancer who underwent repair of hyoid muscle flap were able to tolerate long-term occlusion but did not extubate. One case of glottic laryngeal carcinoma did not extubate due to laryngeal stenosis. CONCLUSIONS: Partial sphincterotomy of the residual throat in laryngectomy may be repaired by different methods according to the intraoperative conditions. For patients with glottic laryngeal carcinoma who underwent vertical laryngectomy, local tissue repair, bilateral pedicled sternal tongue Myofascial flap method, postoperative swallowing functional recovery are satisfied, for the glottis of the laryngeal carcinoma of the ring-shaped cartilage - hyoid bone fixation or patients with supraglottic laryngectomy throat partial resection using Increased scoop area of the repair throat can reduce the method of accidental pharynx, autologous free thyroid cartilage repair is a more simple and effective method.