保留部分环状软骨环的喉全切除术

doi:10.6040/j.issn.1673-3770.0.2017.061

摘要/Abstract

摘要： 目的研究喉癌及下咽癌手术中保留部分环状软骨环对患者的影响。方法回顾性分析32例中晚期喉癌、下咽癌患者,术中采取于环状软骨弓中部水平裂开,只保留部分环状软骨环的喉全切除术,保留的部分环状软骨环与气管一起与颈前造瘘,术后患者不佩戴全喉套管,观察患者咳嗽反射、气道分泌物、造瘘口变化及出院后有无造瘘口狭窄及造瘘口复发情况。结果 32例患者术后均咳嗽反应及气道分泌物明显减少,造瘘口周围红肿较轻。术后随访12~60个月,造瘘口无明显狭窄,无造瘘口肿瘤复发。结论中晚期喉癌及下咽癌患者保留部分环状软骨环的喉全切除术,可避免术后佩戴全喉套管,减少刺激性咳嗽,减轻局部炎症反应,更有利于气道分泌物的排出,缩短患者术后恢复时间,预防气管造瘘口狭窄。

关键词: 喉肿瘤, 下咽肿瘤, 喉切除术, 环状软骨

Abstract: Objective To explore the effect of partial preservation of the cricoid cartilage ring in total laryngectomy. Method The clinical data of 32 patients with laryngeal carcinoma or hypopharyngeal carcinoma were analyzed retrospectively. All patients underwent total laryngectomy with partial preservation of the cricoid cartilage ring. The cricoid cartilage arch was opened at the midline. Tracheostomy was performed with partial preservation of the cricoid cartilage ring. The tracheostomy was monitored postoperatively for inflammatory reactions, stenosis, and tumor recurrence. Results Of 32 patients who underwent this new tracheostomy technique following total laryngectomy, none required postoperative tracheal cannulation. The inflammatory reaction was less than with traditional tracheostomy. There was no tracheostomy stenosis or tumor recurrence during 12 to 60 months of follow-up. Conclusion Some patients with advanced laryngeal or hypopharyngeal carcinoma underwent partial preservation of the cricoid cartilage ring during total laryngectomy and none required postoperative tracheal cannulation. This new tracheostomy technique not only reduced inflammatory reactions, irritating cough, and tracheostomy stenosis, but also shortened the time of postoperative recovery.

Key words: Cricoid cartilage, Laryngeal neoplasms, Hypopharyngeal neoplasms, Laryngectomy

中图分类号:

R767.3

付玉贵,王海兰,孙德重,杨佩珍,陈彦林,陈志鹏. 保留部分环状软骨环的喉全切除术[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 73-75.

FU Yugui, WANG Hailan, SUN Dechong, YANG Peizhen, CHEN Yanlin, CHEN Zhipeng. Total laryngectomy with partial preservation of the cricoid cartilage ring.[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(4): 73-75.

参考文献

[1] 王娜,高伟,陈钢钢,等. 喉组织的肿瘤浸润“屏障”与“通道”的组织切片研究[J].医学研究杂志,2014,43(9):69-71.
[2] 沈伟,殷善开,钱石钧, 等. 喉环上切除术后的嗓音研究[J]. 临床耳鼻咽喉科杂志, 2006,20(15):686-688. SHEN Wei, YIN Shankai, QIAN Shijun, et al. Vocal sound study in supracricoid partial laryngectomy[J]. J Clin Otorhinolaryngol, 2006, 20(15):686-688.
[3] 温树信,秦江波,王斌全,等. 喉功能保留外科相关的喉功能解剖[J].听力学及言语疾病杂志,2016,24(1):31-34. WEN Shuxin, QIN Jiangbo, WANG Binquan, et al. The Laryngeal Anatomic Study of Partial Laryngectomy[J]. J Audiol Speech Pathol, 2016, 24(1):31-34.
[4] Nakayama M, Miyamoto S, Okabe S, et al. Salvage supracricoid laryngectomy after failed radiotherapy and partial laryngectomy[J]. J Laryngol Otol, 2015, 129(1):101-105.
[5] 李晓明,邸斌,陶振峰,等.复发性喉癌挽救性手术保留喉功能初步临床分析[J]. 中华耳鼻咽喉头颈外科杂志,2012,47(7):532-535. LI Xiaoming, DI Bin, TAO Zhenfeng, et al. Preliminary report of laryngeal preservation in the surgical salvage of recurrent laryngeal cancer[J]. Chin J Otorhinolaryngol Head Neck Surg, 2012, 47(7):532-535.
[6] Marioni G, Marchese-Ragona R, Kleinsasser NH, et al. Partial laryngeal surgery in recurrent carcinoma[J]. Acta Otolaryngol, 2015, 135(2):119-124.
[7] De Virgilio A, Greco A, Gallo A, et al. Tracheostomal stenosis clinical risk factors in patients who have undergone total laryngectomy and adjuvant radiotherapy[J]. Eur Arch Otorhinolaryngol, 2013, 270(12):3187-3189.
[8] Kim YH, Kim NH, Seong SY, et al. Double reversing Z-plasty with inferiorly widening stomaplasty for the management of tracheostomal stenosis[J]. Auris Nasus Larynx, 2010, 37(3):361-364.
[9] Lázaro de Frutos P. “The neocricoid”: A new surgical technique to prevent and treat tracheostomal stenosis after total infracricoid laryngectomy[J]. Acta Otorrinolaringol Esp, 2011, 62(3):228-230.
[10] 胡连德,朱旭,任树北,等. 喉全切除后气管断端正中切瘘口成形防颈部造瘘口狭窄(附35例报道)[J]. 临床耳鼻咽喉科杂志,2014,28(23):1897-1898.

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