Zhang J, Wang Q, Li Y, Fan G K
Department of Otorhinolaryngology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou310009, China Department of Otorhinolaryngology, the First People's Hospital of Linping District, Hangzhou311100, China.
Department of Otorhinolaryngology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou310009, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 Dec 7;59(12):1337-1342. doi: 10.3760/cma.j.cn115330-20240614-00353.
To explore the feasibility of one-stage repair and reconstruction of glottic area wounds with the ventricular mucosal flap to prevent postoperative vocal cord adhesion in patients with T1b glottic laryngeal cancer. This case series study involved the research and analysis of clinical data of 12 patients with T1b glottic laryngeal cancer treated in the Department of Otorhinolaryngology, the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2021 to June 2023. All patients were male, aged 50-85 years (median age 64.5 years), and underwent CO laser vocal cord resection under oral support laryngoscopy, followed by one-stage reconstruction of the glottic wound using a ventricular mucosal flap transfer. Postoperative observation indicators included oncological efficacy, surgical complications, degree of vocal cord adhesion, and vocal function, with routine follow-up conducted. The preoperative and postoperative Voice Handicap Index (VHI) scores were compared using a paired-sample Wilcoxon signed-rank test. All 12 patients were followed up for more than 1 year, with follow-up periods ranging from 12 to 37 months and a median follow-up period of 19.5 months. During the follow-up period, no tumor recurrence was observed in any of the patients. One patient experienced suture detachment and displacement of the ventricular mucosal flap postoperatively, and no patient reported respiratory distress symptoms after surgery. 6 patients had no postoperative vocal cord adhesion, and the vocal cord length ratio in 12 patients was (0.80±0.23). The maximum glottic opening angle after surgery was (46.5±7.7) degrees. Voice function was evaluated before surgery and in six months postoperatively, when the laryngeal mucosa was on the stable phase. The median VHI-10 score for the 12 patients was 20 preoperatively and 10 postoperatively, the difference was statistically significant (=-2.827,<0.05). The application of ventricular mucosal flap repair and reconstruction for glottic wound following laser resection of T1b laryngeal cancer effectively prevents postoperative vocal cord adhesion. The postoperative recovery of vocal function in these patients is favorable.
探讨采用室带黏膜瓣一期修复重建声门区创面预防T1b期声门型喉癌患者术后声带粘连的可行性。本病例系列研究对2021年1月至2023年6月在浙江大学医学院附属第二医院耳鼻咽喉科治疗的12例T1b期声门型喉癌患者的临床资料进行研究分析。所有患者均为男性，年龄50 - 85岁（中位年龄64.5岁），在支撑喉镜下接受CO2激光声带切除术，随后采用室带黏膜瓣转移一期重建声门创面。术后观察指标包括肿瘤学疗效、手术并发症、声带粘连程度及嗓音功能，并进行常规随访。采用配对样本Wilcoxon符号秩和检验比较术前和术后嗓音障碍指数（VHI）评分。12例患者均随访1年以上，随访时间为12 - 37个月，中位随访时间为19.5个月。随访期间，所有患者均未观察到肿瘤复发。1例患者术后出现室带黏膜瓣缝线脱落移位，术后无患者出现呼吸窘迫症状。6例患者术后无声带粘连，12例患者声带长度比为（0.80±0.23）。术后最大声门开口角度为（46.5±7.7）度。在术前及术后6个月（喉黏膜处于稳定期）对嗓音功能进行评估。12例患者术前VHI - 10评分中位数为20，术后为10，差异有统计学意义（Z = - 2.827，P<0.05）。T1b期喉癌激光切除术后采用室带黏膜瓣修复重建声门创面可有效预防术后声带粘连，患者术后嗓音功能恢复良好。
