Kimata Y, Uchiyama K, Ebihara S, Saikawa M, Hayashi R, Haneda T, Ohyma W, Kishimoto S, Asai M, Nakatsuka T, Harii K
Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Plast Reconstr Surg. 2000 Oct;106(5):1028-35. doi: 10.1097/00006534-200010000-00012.
Microsurgical reconstruction after total glossectomy can greatly improve quality of life; however, postoperative functional results are often unstable, and the effectiveness of total glossectomy remains questionable. To determine the problems of reconstruction after total glossectomy with laryngeal preservation and to examine the functional results of swallowing and speech, 30 patients who had undergone total glossectomy and reconstruction with free flaps were reviewed for this study. The patients ranged in age from 20 to 73 years, and 23 of the 30 had undergone reconstruction with a rectus abdominis musculocutaneous flap. Wider and thicker flaps were designed and transferred and were sutured to suspend the larynx. To maintain physiologic swallowing function after surgery, the extent of laryngeal suspension and cricopharyngeal myotomy was limited. Of the 30 patients, 21 (70 percent) could be decannulated with laryngeal preservation; 20 of these 21 could tolerate a normal/soft/pureed diet, and 1 was limited to a fluid diet. Speech was intelligible in 16 of the 19 patients evaluated. In 9 of the 30 patients, laryngeal function could not be preserved. In four of these nine patients, additional resection combined with total glossectomy caused severe aspiration and recurrent pneumonia. Two patients with preoperative cerebral dysfunction were also poor candidates for laryngeal preservation. Additionally, the transferred flap's lack of bulk in the oral cavity and the advanced age (73 years) of one patient and the poor motivation of another may have contributed to postoperative aspiration. Aspiration occurred in one patient because of local recurrence of a tumor. The presence of preoperative cerebral dysfunction (p = 0.025), resection of the epiglottis (p = 0.005), and postoperative orocutaneous fistulas (p = 0.04) were significantly associated with the failure of laryngeal preservation. However, because of the difficulty of enrolling a sufficient number of patients in the study and the inherent limitations of retrospective studies, multivariate analysis in this study showed that no factors, such as patient age, flap volume, and the type of neck dissection, were significant predictors of laryngeal preservation. Although prospective studies are necessary, the function of individual patients must be assessed so that the study experiences discussed here can be applied to subsequent patients.
全舌切除术后的显微外科重建可显著改善生活质量；然而，术后功能结果往往不稳定，全舌切除术的有效性仍存在疑问。为了确定保留喉功能的全舌切除术后重建的问题，并检查吞咽和言语的功能结果，本研究回顾了30例行全舌切除及游离皮瓣重建术的患者。患者年龄在20至73岁之间，30例中有23例采用腹直肌肌皮瓣进行重建。设计并转移了更宽更厚的皮瓣，并进行缝合以悬吊喉部。为了术后维持生理吞咽功能，喉部悬吊和环咽肌切开术的范围受到限制。30例患者中，21例（70%）保留喉功能后可拔除气管套管；这21例中的20例能够耐受正常/软食/泥状食物，1例仅能进食流食。在评估的19例患者中，16例的言语可理解。30例患者中有9例无法保留喉功能。这9例中的4例，额外切除联合全舌切除术导致严重误吸和反复肺炎。2例术前存在脑功能障碍的患者也不适合保留喉功能。此外，转移皮瓣在口腔内缺乏丰满度、1例患者年龄较大（73岁）以及另1例患者积极性不高可能导致了术后误吸。1例患者因肿瘤局部复发出现误吸。术前存在脑功能障碍（p = 0.025）、会厌切除（p = 0.005）和术后口皮瘘（p = 0.04）与喉功能保留失败显著相关。然而，由于本研究纳入足够数量患者存在困难以及回顾性研究的固有局限性，本研究的多因素分析显示，患者年龄、皮瓣体积和颈部清扫类型等因素均不是喉功能保留的显著预测因素。尽管前瞻性研究很有必要，但必须评估个体患者的功能，以便将此处讨论的研究经验应用于后续患者。
