Tu G, Tang P, He Y
Cancer Hospital, CAMS, Beijing
Zhonghua Er Bi Yan Hou Ke Za Zhi. 1996;31(1):39-42.
The surgical defect after conventional partial laryngectomy practically needs no special technique to repair. On conservation surgery for late (T3 and T4) cases a large part of the larynx is to be resected so that the margin of surgical clearance is ample and, at the same time, an appropriate method of reconstruction is mandatory to restore the essential functions of the larynx. For this purpose we developed a technique of osteomuscular flap to repair the defect left behind after a three-fourths laryngectomy (for supraglottic case) or an extended vertical partial laryngectomy (for glottic case). In both cases the arytenoid cartilage or the cricoarytenoid joint was resected to ensure the safety margin of resection. The mylohyoid muscle was severed at the upper border of the body of the hyoid bone. A small piece of the hyoid bone (about 5 mm) and its attached strap muscles were used. The muscles were made a 90 degree bent toward the laryngeal cavity. The hyoid bone was used to substitute the removed arytenoid and the muscles to bridge over the laryngeal lumen. The postericoid mucosa was advanced to cover the transplanted hyoid bone. Then the cut edge of the thyroid cartilage was lifted up and sutured with the base of the tongue to close the wound. 108 cases were treated within a period of 12 years (1979-1990). The three year survival rates for stage II and stage IV of supraglottic type (66 cases) were 78.6% and 66.7% respectively, and for stage II of glottic type (42 cases), 79.3%. The decannulation rate was 75%-85%, and 80% of the patients enjoyed a socially acceptable voice. All cases resumed normal mouth-food-taking.
传统部分喉切除术后的手术缺损实际上无需特殊技术修复。对于晚期（T3和T4）病例的保留性手术，需要切除大部分喉，以便手术切缘充分，同时，必须采用适当的重建方法来恢复喉的基本功能。为此，我们开发了一种骨肌瓣技术，用于修复四分之三喉切除术后（声门上型病例）或扩大垂直部分喉切除术后（声门型病例）留下的缺损。在这两种情况下，均切除杓状软骨或环杓关节以确保切除的安全切缘。在舌骨体上缘切断下颌舌骨肌。使用一小片舌骨（约5mm）及其附着的带状肌。将肌肉向喉腔弯曲90度。用舌骨替代切除的杓状软骨，用肌肉桥接喉腔。将后杓黏膜推进覆盖移植的舌骨。然后将甲状软骨的切缘提起并与舌根缝合以关闭伤口。在12年（1979 - 1990年）期间共治疗108例患者。声门上型（66例）II期和IV期的三年生存率分别为78.6%和66.7%，声门型（42例）II期为79.3%。拔管率为75% - 85%，80%的患者声音可被社会接受。所有病例均恢复正常经口进食。
