| 摘要: |
| 目的 评价应用颈前旋转肌皮瓣修复喉部分切除术后缺损的喉功能恢复效果。方法 我院2008年至2010年间有完整喉功能随访资料的行喉部分切除+颈前旋转肌皮瓣重建术的患者43例,其中声门型32例(Ⅱ期15例,Ⅲ期16例,Ⅳ期1例),跨声门型11例(Ⅱ期5例,Ⅲ期6例),分别行垂直半喉切除术、扩大垂直喉切除术、扩大额侧喉切除术、次全喉切除术, 同期应用颈前双蒂旋转肌皮瓣进行喉重建。统计误咽率和拔管率,并对吞咽功能评分、呼吸功能评分和嗓音参数做手术前、后对比分析。结果 术后6个月时全部患者恢复正常吞咽防护和呼吸功能,进食无误咽,气管套管拔出率为100%,吞咽功能评分与术前比较差异无统计学意义(U=903.1,P=0.559),呼吸功能较术前改善(U=713.5,P=0.012)。全部患者能够正常发音。术后6个月时基频微扰(Jitter)、振幅微扰(Shimmer)和声门噪声能量(NNE)值优于术前(P<0.05),但嗓音参数基频(F0)值较术前下降(P<0.05)；术后>12个月NNE较术后6个月时有所改善，差异有统计学意义(P<0.05)。结论 应用颈前旋转肌皮瓣修复喉部分切除术后缺损拔管率高、发音恢复效果好,喉功能恢复效果满意。 |
| 关键词: 喉部分切除术 外科皮瓣 吞咽 呼吸 |
| DOI： |
| 投稿时间：2013-03-20修订日期：2013-04-10 |
| 基金项目: |
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| Functional recovery of laryngeal reconstruction with the anterior cervical turnover myocutaneous flap after partial laryngectomy |
| WANG Jia-sen,LI Li,XIAO Liao-yuan,WANG Cheng-yu,SHEN Jun,YANG Yu-mei,LANG Jun-tian,ZHAO Shu-wei* |
(Department of Otolaryngology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
*Corresponding author.) |
| Abstract: |
| Objective To evaluate the laryngeal function recovery following laryngeal defect reconstruction with anterior cervical turnover myocutaneous flap after partial laryngectomies. Methods The swallowing, respiration and phonation functions of 43 patients, who received vertical partial laryngectomy, extended vertical partial laryngectomy, expanded frontovertical partial laryngectomy or subtotal laryngectomy, and laryngeal reconstruction with turnover myocutaneous flap between 2008 and 2010, were retrospectively analyzed. Thirty-two patients had glottic carcinoma (15 phase Ⅱ,16 phase Ⅲ, 1 phase Ⅳ) and 11 had transglottic carcinoma (5 phase Ⅱ,6 phase Ⅲ). The aspiration rate and decannulation rate were recorded. The swallowing function score, respiration function score, and voice parameters were analyzed and compared before and after operation. Results Six months after operation all the cases had normal swallowing and respiration functions, with no aspiration and with a decannulation rate of 100%. The swallowing function scores were similar before and after operation (U=903.1,P=0.559), and the respiratory function was significantly improved after operation (U=713.5,P=0.012). All the cases had normal voice. Six months after operation, the voice quality (such as Jitter, Shimmer and normalized noise energy \[NNE\]) were significantly better than that before the operation (P<0.05). The fundamental frequency (F0) of voice was significantly decreased after operation (P<0.05), and the NNE at >12 months after operation was significantly better than that at 6 months after operation (P<0.05). Conclusion Anterior cervical turnover myocutaneous flap for reconstruction of laryngeal defects following partial laryngectomies can achieve high decannulation rate and better phonation recovery, showing a satisfactory restoration of laryngeal function. |
| Key words: laryngectomy surgical flaps deglutition respiration |
