局部组织瓣在喉切除术后一期重建中的应用
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摘要
目的探讨局部组织瓣在喉切除术后一期重建中的应用方法及效果。方法 2002年至2011年山东大学齐鲁医院耳鼻咽喉科对因喉恶性肿瘤住院的患者行手术治疗,并应用胸骨舌骨肌瓣、接力肌瓣、会厌瓣、颈前皮瓣、胸大肌肌皮瓣于喉切除后一期重建喉腔及喉功能。结果随访喉癌患者共计658例,均行气管切开术,一期手术均成功保留喉功能。应用胸骨舌骨肌瓣546例、接力肌瓣45例、会厌瓣39例、颈前皮瓣28例、胸大肌肌皮瓣1例。结论局部组织瓣具备取材丰富、制备简单、方式多样、血运良好的特点,可极大程度满足大多数喉腔术后一期重建的要求,在喉恶性肿瘤的喉功能保留手术中有着不可替代的作用。
Objective To discuss and evaluate the application and outcomes of local tissue flaps in primary reconstruction of laryngeal function after laryngectomy. Methods A retrospective analysis of 658 operations in patients with laryngeal carcinoma from the Department of Otolaryngology,Qilu Hospital of Shandong University,was performed. The patients underwent primary reconstruction of laryngeal function immediately following laryngectomy using the sternohyoid flap,thyrohyoid flap,epiglottis flap,pre-cervical skin flap,and/or pectoralis major flap. Results All patients received a tracheotomy and had their laryngeal function preserved in the primary surgery. Five hundred and forty-six patients underwent single or combination sternohyoid flap reconstruction. Fortyfive patients underwent single or combination thyrohyoid flap reconstruction. Thirty-nine patients underwent reconstruction with the epiglottis flap. Twenty-eight patients underwent reconstruction with the pre-cervical skin flap. The total 3-year survival rate was 83.01%,and the total 5-year survival rate was 72.53%. The total extubation rate was 86.04%. Conclusion The use of local tissue flaps is advantageous for reconstruction in head and neck surgery because of their good blood supply,their ability to support a variety of surgical options,and the surgical simplicity of the operations in which they are used. Local flaps play an important role in onestage reconstruction of laryngeal function when used flexibly.
Objective To discuss and evaluate the application and outcomes of local tissue flaps in primary reconstruction of laryngeal function after laryngectomy. Methods A retrospective analysis of 658 operations in patients with laryngeal carcinoma from the Department of Otolaryngology,Qilu Hospital of Shandong University,was performed. The patients underwent primary reconstruction of laryngeal function immediately following laryngectomy using the sternohyoid flap,thyrohyoid flap,epiglottis flap,pre-cervical skin flap,and/or pectoralis major flap. Results All patients received a tracheotomy and had their laryngeal function preserved in the primary surgery. Five hundred and forty-six patients underwent single or combination sternohyoid flap reconstruction. Fortyfive patients underwent single or combination thyrohyoid flap reconstruction. Thirty-nine patients underwent reconstruction with the epiglottis flap. Twenty-eight patients underwent reconstruction with the pre-cervical skin flap. The total 3-year survival rate was 83.01%,and the total 5-year survival rate was 72.53%. The total extubation rate was 86.04%. Conclusion The use of local tissue flaps is advantageous for reconstruction in head and neck surgery because of their good blood supply,their ability to support a variety of surgical options,and the surgical simplicity of the operations in which they are used. Local flaps play an important role in onestage reconstruction of laryngeal function when used flexibly.
引文
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[12]潘新良,张立强,许风雷.胸骨舌骨肌筋膜瓣舌根成形术治疗晚期喉声门上型癌[J].中国耳鼻咽喉头颈外科,2005,12(4):12-14.PAN Xinliang,ZHANG Liqiang,XU Fenglei.Reconstruction of tongue base by sternohyoid myofascial flap in surgical treatment of advanced supraglottic carcinoma[J].Chin Archives Otolaryngol Head Neck Surg,2005,12(4):12-14.
[13]Tucker HM,Wood BG,Levine H,et al.Glottic reconstruction after near total laryngectomy[J].Laryngoscope,1979,89(4):609-618.
[14]王惠忠,栾信庸,李勇.会厌在喉气管狭窄整复中的应用[J].中国修复重建外科杂志,2005,19(2):138-140.WANG Huizhong,LUAN Xinyong,LI Yong.Application of epiglottic in reconstruction of traumatic laryngotracheal stenosis[J].Chin J Rep Rec Surg,2005,19(2):138-140.
[15]Fajdiga I,Groselj A.Epiglottoplasty for reconstruction of defects after laryngectomy w ith partial pharyngectomy[J].Ann Otol Rhinol Laryngol,2010,119(9):636-640.
[16]陈志飞,王斌全,张春明.喉垂直部分切除术后喉功能修复与重建的研究进展[J].中国现代医生,2016,54(32):159-161.
[17]王天铎,朱萍.纵位半喉及喉次全切除颈前皮瓣整复术[J].山东医药,1979(2):11-13.
[18]Dursun G,Ozgursoy OB.Laryngeal reconstruction by platysma myofascial flap after vertical partial laryngectomy[J].Head Neck,2005,27(9):762-770.
[19]潘新良,栾信庸,解光,等.胸大肌肌皮瓣在耳鼻咽喉头颈外科中的应用[J].山东大学耳鼻喉眼学报,2005,19(5):277-282.PAN Xinliang,LUAN Xinyong,XIE Guang,et al.Application of pectoralis major myocutaneous flap in otorhinolaryngology&head and neck surgery[J].J Otolaryngol Ophthalmol Shandong Univ,2005,19(5):277-282.
[20]Allegra E,Lombardo N,La Boria A,et al.Quality of voice evaluation in patients treated by supracricoid laryngectomy and modified supracricoid laryngectomy[J].Otolaryngol Head Neck Surg,2011,145(5):789-795.
[21]Farrag TY,Koch WM,Cummings CW,et al.Supracricoid lar-yngectomy outcomes:the Johns Hopkins experience[J].Laryngoscope,2007,117:129-132.
[22]Galli A,Giordano L,Sarandria D,et al.Oncological and complication assessment of CO2laser-assisted endoscopic surgery for T1-T2 glottic tumours:clinical experience[J].Acta Otorhinolaryngol Ital,2016,36(3):167-173.
[2]霍红.双蒂双肌瓣在喉垂直部分切除术中的应用[J].山东大学耳鼻喉眼学报,2009,23(3):67-68.
[3]Dong P,Li X,Wang G.Repair with sternohyoid muscle fascia after subtotal laryngectomy[J].J Laryngol Otol Suppl,2009(31):18-23.
[4]陈志俊,孙彦,华辉,等.会厌瓣和胸骨舌骨肌肌筋膜瓣在喉癌喉部分切除喉功能重建中的应用[J].临床耳鼻咽喉科杂志,2005,19(15):15-19.CHEN Zhijun,SUN Yan,HUA Hui,et al.Application of partial laryngectomy in laryngeal cancer treatment and reconstruction w ith epiglottic flap and bi-pedicle muscle flap[J].J Clinical Otorhinolaryngol,2005,19(15):15-19.
[5]Wang HS,Shen JW,Ma DB,et al.The infra-hyoidmyocutaneous flap for reconstruction after resection of head and neck cancer[J].Cancer,1986,57:663-668.
[6]Yu Y,Wang XL,Xu ZG,et al.Laryngeal reconstruction w ith a sternohyoid muscle flap after supracricoid laryngectomy:postoperative respiratory and sw allow ing evaluation[J].Otolaryngol Head Neck Surg,2014,151(5):824-829.
[7]Laurentjoye M,Ricard AS,Caix P,et al.Tongue reconstruction w ith a bilateral infrahyoid flap innervated by Ansa Cervicalis after total glossectomy[J].Rev Stomatol Chir M axillofac,2011,112(6):337-341.
[8]Rifai M,Hassouna MS,Abdel Fattah Ael F,et al.Experience w ith supracricoid laryngectomy variants[J].Head Neck,2011,33(8):1177-1183.
[9]Hantzakos A,Evrard AS,Lawson G,et al.Posthemicricoidectomy reconstruction w ith a composite hyoid-sternohyoid osseomuscular flap:the Rethi-Ward technique[J].Eur Arch Otorhinolaryngol,2007,264(11):1339-1342.
[10]屠规益,唐平章,贺永东,等.应用舌骨肌瓣修复部分喉术后缺损[J].中华耳鼻咽喉科杂志,1996,31(1):39-42.
[11]王德生,黄建民,林国经,等.双蒂接力肌甲状软骨膜瓣在喉功能重建中的应用[J].临床耳鼻咽喉头颈外科杂志,2005,19(18):856-857.
[12]潘新良,张立强,许风雷.胸骨舌骨肌筋膜瓣舌根成形术治疗晚期喉声门上型癌[J].中国耳鼻咽喉头颈外科,2005,12(4):12-14.PAN Xinliang,ZHANG Liqiang,XU Fenglei.Reconstruction of tongue base by sternohyoid myofascial flap in surgical treatment of advanced supraglottic carcinoma[J].Chin Archives Otolaryngol Head Neck Surg,2005,12(4):12-14.
[13]Tucker HM,Wood BG,Levine H,et al.Glottic reconstruction after near total laryngectomy[J].Laryngoscope,1979,89(4):609-618.
[14]王惠忠,栾信庸,李勇.会厌在喉气管狭窄整复中的应用[J].中国修复重建外科杂志,2005,19(2):138-140.WANG Huizhong,LUAN Xinyong,LI Yong.Application of epiglottic in reconstruction of traumatic laryngotracheal stenosis[J].Chin J Rep Rec Surg,2005,19(2):138-140.
[15]Fajdiga I,Groselj A.Epiglottoplasty for reconstruction of defects after laryngectomy w ith partial pharyngectomy[J].Ann Otol Rhinol Laryngol,2010,119(9):636-640.
[16]陈志飞,王斌全,张春明.喉垂直部分切除术后喉功能修复与重建的研究进展[J].中国现代医生,2016,54(32):159-161.
[17]王天铎,朱萍.纵位半喉及喉次全切除颈前皮瓣整复术[J].山东医药,1979(2):11-13.
[18]Dursun G,Ozgursoy OB.Laryngeal reconstruction by platysma myofascial flap after vertical partial laryngectomy[J].Head Neck,2005,27(9):762-770.
[19]潘新良,栾信庸,解光,等.胸大肌肌皮瓣在耳鼻咽喉头颈外科中的应用[J].山东大学耳鼻喉眼学报,2005,19(5):277-282.PAN Xinliang,LUAN Xinyong,XIE Guang,et al.Application of pectoralis major myocutaneous flap in otorhinolaryngology&head and neck surgery[J].J Otolaryngol Ophthalmol Shandong Univ,2005,19(5):277-282.
[20]Allegra E,Lombardo N,La Boria A,et al.Quality of voice evaluation in patients treated by supracricoid laryngectomy and modified supracricoid laryngectomy[J].Otolaryngol Head Neck Surg,2011,145(5):789-795.
[21]Farrag TY,Koch WM,Cummings CW,et al.Supracricoid lar-yngectomy outcomes:the Johns Hopkins experience[J].Laryngoscope,2007,117:129-132.
[22]Galli A,Giordano L,Sarandria D,et al.Oncological and complication assessment of CO2laser-assisted endoscopic surgery for T1-T2 glottic tumours:clinical experience[J].Acta Otorhinolaryngol Ital,2016,36(3):167-173.