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目的评价应用颈前旋转肌皮瓣修复喉部分切除术后缺损的喉功能恢复效果。方法我院2008年至2010年间有完整喉功能随访资料的行喉部分切除+颈前旋转肌皮瓣重建术的患者43例,其中声门型32例(Ⅱ期15例,Ⅲ期16例,Ⅳ期1例),跨声门型11例(Ⅱ期5例,Ⅲ期6例),分别行垂直半喉切除术、扩大垂直喉切除术、扩大额侧喉切除术、次全喉切除术,同期应用颈前双蒂旋转肌皮瓣进行喉重建。统计误咽率和拔管率,并对吞咽功能评分、呼吸功能评分和嗓音参数做手术前、后对比分析。结果术后6个月时全部患者恢复正常吞咽防护和呼吸功能,进食无误咽,气管套管拔出率为100%,吞咽功能评分与术前比较差异无统计学意义(U=903.1,P=0.559),呼吸功能较术前改善(U=713.5,P=0.012)。全部患者能够正常发音。术后6个月时基频微扰(Jitter)、振幅微扰(Shimmer)和声门噪声能量(NNE)值优于术前(P<0.05),但嗓音参数基频(F0)值较术前下降(P<0.05);术后>12个月NNE较术后6个月时有所改善,差异有统计学意义(P<0.05)。结论应用颈前旋转肌皮瓣修复喉部分切除术后缺损拔管率高、发音恢复效果好,喉功能恢复效果满意。
Objective To evaluate the effect of repairing laryngeal function after partial laryngectomy using anterior cervical myocutaneous flap. Methods Forty-three patients with throat partial myomectomy and anterior cervical myocutaneous flap reconstruction from 2008 to 2010 with complete laryngeal function follow-up data were included in this study. Among them, 32 cases were glottic (15 cases in stage Ⅱ, 16 cases in stage Ⅲ, 1 in stage Ⅳ), 11 cases of transglottic type (5 cases in stage Ⅱ and 6 cases in stage Ⅲ) were treated by vertical semichectomy, vertical laryngectomy, maxillary lateral laryngectomy and subtotal laryngectomy In the same period, the double pedicle rotation myocutaneous flap was used to reconstruct the larynx. Statistics of swallowing rate and extubation rate, and swallowing function score, respiratory function score and voice parameters before and after surgery, comparative analysis. Results All patients returned to normal swallowing protection and respiratory function at 6 months after operation. The rate of tracheal cannula pull-out was 100%, and the swallowing function score was not significantly different from preoperative (U = 903.1, P = 0.559), respiratory function improved than preoperative (U = 713.5, P = 0.012). All patients can pronounce properly. Jitter, Shimmer and NNE at 6 months after operation were better than those before operation (P <0.05), but the fundamental frequency (F0) (P <0.05). The NNE of postoperative 12 months was better than that of 6 months after operation (P <0.05). Conclusions The application of anterior cervical myocutaneous flap in the repair of laryngectomy has the advantages of high extubation rate, good phonetic recovery, and satisfactory laryngeal function recovery.