Dong P, Li X, Wang G, Chen X, Xie J, Nakashima T
Department of Otolaryngology-Head and Neck Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, China.
J Laryngol Otol Suppl. 2009(31):18-23. doi: 10.1017/S0022215109005039.
The subtotal laryngectomy procedure enables the patient to avoid some of the serious consequences of total laryngectomy without having to relinquish oncological effectiveness. However, the important complication of aspiration may still seriously affect some patients. Many methods of reconstruction have been described in an attempt to avoid or minimise this complication.
Thirty-nine patients (15 with supraglottic laryngeal cancer and 24 with hypopharyngeal cancer) who had undergone subtotal laryngectomy between 2000 and 2006 were included in this study. In all patients, a sternohyoid muscle flap has been used for primary, one-stage reconstruction of laryngopharyngeal defects, following resection of advanced stage lesions. Patients' times to oral intake and decannulation, their speech function and their post-operative complications were reviewed.
The patients' three-year overall survival rate was 46.1 per cent. Their mean time to oral intake was 14 days. Twenty-six patients were decannulated (66.7 per cent). Almost all patients regained their speech function post-operatively, although their voice quality was not as good as before surgery.
Sternohyoid muscle fascia reconstruction leads to optimal repair of subtotal laryngectomy defects and restored laryngeal function.
次全喉切除术能使患者避免全喉切除术的一些严重后果，同时又不必牺牲肿瘤治疗效果。然而，误吸这一重要并发症仍可能严重影响部分患者。为避免或减少该并发症，已描述了多种重建方法。
本研究纳入了2000年至2006年间接受次全喉切除术的39例患者（15例声门上喉癌患者和24例下咽癌患者）。所有患者在切除晚期病变后，均采用胸骨舌骨肌瓣对喉咽缺损进行一期原位重建。回顾了患者开始经口进食和拔管的时间、言语功能及术后并发症情况。
患者的三年总生存率为46.1%。他们开始经口进食的平均时间为14天。26例患者拔管（66.7%）。几乎所有患者术后恢复了言语功能，尽管其嗓音质量不如手术前。
胸骨舌骨肌筋膜重建可实现次全喉切除术后缺损的最佳修复并恢复喉功能。
