摘要
目的:
建立动物模型研究不做气管切开的改良额侧位喉部分切除重建术治疗早期声带癌的可行性,探索其适应症及在临床实践中的应用,验证理论计算结果。
方法:
解剖6只毕格犬的喉体,对其原始声门面积、额侧位部分切除后关闭甲状软骨切缘后的声门面积以及额侧位部分切除后开放甲状软骨切缘后的声门面积进行测量,分别比较各组数据之间的差异,建立理论模型,验证改良额侧位喉部分切除重建术的可行性。对10只毕格犬分别进行喉裂开右侧声带切除术、改良额侧位喉部分切除重建术以及扩大改良额侧位喉部分切除重建术,测量并比较各组术后声门面积,在活体动物中验证改良额侧位喉部分切除重建术的可行性,探索其同传统手术的差异。
结果:
离体组:额侧位部分切除后闭合甲状软骨同原始声门面积有差异(t=5.74 P<0.05);额侧位部分切除后开放甲状软骨同原始声门面积无差异(t=2.47 P>0.05)。在体组:所有实验动物在接受扩大改良额侧位喉部分切除重建术后,除一例因麻醉过深造成死亡外均饲养并观察48小时后处死,期间除该例外,无一例出现呼吸困难。喉裂开右侧声带切除术后声门面积同术前声门面积无差异(Q=0.047 P>0.05);改良额侧位喉部分切除重建术后声门面积同术前声门面积无差异(Q=8.74 P>0.05);改良额侧位喉部分切除重建术后声门面积同喉裂开右侧声带切除术后声门面积无差异(Q=8.78 P>0.05);扩大改良额侧位喉部分切除重建术后声门面积同术前声门面积有差异(T= 40.00 P<0.05)。切除前20%的声带及甲状软骨较为安全可靠,无需行气管切开。
结论:
动物实验证实将甲状软骨外展后成‘梯’型使截面积扩大而改良的额侧位喉部分切除重建术具有可行性,不做气管切开具有试验依据。
Objective:
To build an animal model in order to investigate and to highlight new developments in the treatment of early true vocal cord cancer with modified frontolateral partial laryngectomy without tracheostomy. Methods:
To measure the areas of 6 canines` excised larynges in the following states: initial state; after modified frontolateral partial laryngectomy without tracheotomy and with the cartilage closed; after modified frontolateral partial laryngectomy without tracheotomy and with the cartilage open. Comparing the data of all 6 canines in order to establish the theoretical model to confirm the feasibility of modified frontolateral partial larnygectomy without tracheotomy. To measure the areas of 6 canines` larynes in the following states: after right chordectomy with laryngofission; after modified frontolateral partial larnygectomy without tracheostomy; after enlarged modified frontolateral partial larnygectomy without tracheotomy. Comparing the data of all 10 canines in order to confirm the feasibility of modified frontolateral partial laryngectomy without tracheotomy in vivo.
Results:
Ex vivo group: The areas of 6 canines` excised larynx in initial state and areas of 6 canines` excised larynx after modified frontolateral partial laryngectomy without tracheotomy and with the cartilage closed showed significant deviation(t=5.74 P<0.05). The areas of 6 canines` excised larynx in initial state and areas of 6 canines` excised larynx after modified frontolateral partial laryngectomy without tracheotomy and with the cartilage open showed no significant deviation(t=2.47 P>0.05). In vivo group: All the experimental animals were alive for 48 hours except one which was killed by anesthesia. No experimental animal suffered from dyspnea, except the one which was killed by anesthesia. The areas of 10 canines` larynges in initial state and the areas of 10 canines` larynges after right chordectomy with laryngofission showed significant deviation(Q=0.047 P>0.05); The areas of 10 canines` larynx in initial state and areas of 10 canines` larynges after modified frontolateral partial laryngectomy without tracheotomy showed no significant deviation(Q=8.74 P>0γ.05); The areas of 10 canines` larynx in initial state and areas of 10 canines` larynges after enlarged modified frontolateral partial laryngectomy without tracheotomy showed significant deviation(T= 40.00 P<0.05); Conclusions:
Modified frontolateral partial laryngectomy without tracheostomy is an expeditious and highly successful means of eradicating early and selected invasive glottic squamous cell carcinomas,which is proved by animal experiment.
引文
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