Su Chih-Ying, Chuang Hui-Ching, Tsai Shang-Shyue, Chiu Jeng-Fen
Department of Otolaryngology and Speech Center, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan.
Laryngoscope. 2005 Mar;115(3):528-33. doi: 10.1097/01.MLG.0000150091.55295.56.
In treating early glottic carcinomas, the outcomes of endoscopic laser cordectomy have been proven to be valuable in local control, survival, and vocal function preservation. In some extended cases, however, laser cordectomy may leave patients with poor vocal function because of vocal fold deficit. This work assesses the vocal outcome of medialization laryngoplasty with bipedicled strap muscle transposition for vocal fold deficit resulting from laser cordectomy in early glottic cancer patients.
A prospective clinical series.
Thirteen early glottic cancer patients who had vocal fold deficit caused by previous laser cordectomy underwent medialization laryngoplasty with bipedicled strap muscle transposition. The thyroid lamina on the cordectomy side was paramedially separated. The inner perichondrium was circumspectly raised from the overlying thyroid cartilage. After separating the thyrohyoid and cricothyroid membranes, the lamina was retracted laterally. A bipedicled strap muscle flap was then transposed into the area between the lamina and the paraglottic soft tissue. The thyroid cartilages were carefully sutured back in position. All patients received pre- and postoperative voice assessments comprising laryngostroboscopy and vocal function studies.
Vocal enhancement was present in 92% (12/13) of patients after medialization laryngoplasty with strap muscle transposition. The glottal closure and maximal phonation time were noticeably improved by surgery. No dyspnea or other significant complications were observed in any patients.
The outcomes show that bipedicled strap muscle transposition is a prosthesis-free, safe, and valuable laryngoplastic technique for correcting glottal incompetence caused by endoscopic laser cordectomy in early glottic cancer patients.
在早期声门癌的治疗中，内镜下激光声带切除术在局部控制、生存率及嗓音功能保留方面的效果已得到证实。然而，在一些病情扩展的病例中，由于声带缺损，激光声带切除术可能会导致患者嗓音功能不佳。本研究评估了采用双蒂带状肌转位的喉内移术对早期声门癌患者因激光声带切除术导致的声带缺损的嗓音治疗效果。
一项前瞻性临床系列研究。
13例因先前激光声带切除术导致声带缺损的早期声门癌患者接受了双蒂带状肌转位的喉内移术。在声带切除术一侧将甲状软骨板向内侧分离。小心地将内层软骨膜从上方的甲状软骨掀起。分离甲状舌骨膜和环甲膜后，将甲状软骨板向外侧牵拉。然后将双蒂带状肌瓣转位至甲状软骨板与声门旁软组织之间的区域。仔细将甲状软骨缝合回原位。所有患者在术前和术后均接受了包括喉动态镜检查和嗓音功能研究在内的嗓音评估。
采用带状肌转位的喉内移术后，92%（12/13）的患者嗓音得到改善。手术使声门闭合和最大发声时间有显著改善。所有患者均未观察到呼吸困难或其他严重并发症。
结果表明，双蒂带状肌转位是一种无假体、安全且有效的喉成形技术，可用于纠正早期声门癌患者因内镜下激光声带切除术导致的声门闭合不全。
