摘要
目的：探讨累及喉-气管的甲状腺乳头状癌切除术后喉-气管结构和功能保存、缺损的处理方法。方法：回顾我科2007-2014年13例甲状腺乳头状癌累及喉气管术中喉气管结构保存和缺损处理的治疗效果,其中不包含全喉切除病例。男3例,女10例;年龄46~67岁,中位年龄53岁。初次手术累及喉气管5例,局部复发累及喉气管8例。术前通过纤维喉镜及CT明确病变范围。首次手术患者行甲状腺全切及累及喉气管切除加择区颈淋巴清扫术。复发病例作复发灶及累及喉气管部分切除加择区颈淋巴清扫术。缺损的处理采用3种方式。带蒂胸锁乳突肌锁骨骨膜皮瓣、颈阔肌带蒂皮瓣或保留缺损段喉气管结构喉气管造瘘、待二期修复的处理方法。术后随访半年到3年。结果：13例患者中10例拔管,3例终身带管（其中2例二期皮瓣转移缩小造瘘口）。结论：选择适当病例,选用皮瓣转移或喉气管造瘘二期修复,都可以保留部分喉气管结构和功能,提高患者生存质量。
Objective：To investigate the preservation of the structure and function of the trachea and larynx,the management of laryngotracheal defect when trachea and larynx was involved.Method：To review the management and clinical results of 13 cases of thyroid papillary carcinoma with larynx and trachea involvement,the preservation of laryngotracheal structure and relative defect reconstruction of our department from 2007-2014.Those patients being performed total laryngectomy was excluded.3 males and 10 females,aged from 46 to 67 years old with median age of 53 were included.Among them 8 cases were recurrent.The extent of the tumor foci was estimated with the help of computed tomography and laryngofiberoscope before surgery.Selective neck dissection,total thyroidectomy and related laryngotracheal resection was performed for the first time operation patient,while selective neck dissection,recurrent foci and related larynx and trachea resection was performed for those recurrent patients.Three kinds of modalities were applied to manage the laryngotracheal defect including to reconstruct with pedicled sternocleidomastoid clavicular periosteocutaneous flap,pedicled trapizius muscular flap and to preserve the remaining larynx and trachea and perform a stoma of larynx and trachea which repaired by a second-stage procedure.The patients were followed-up from half an year to 3 years.Result：Ten patients out of 13 decannulated while another 3 cases,2of which were performed local flap to reduce the stoma,wore tracheal tubes all time.Conclusion：Either flap transfer or laryngotracheal stoma before second stage repair might preserve partial laryngotacheal anatomy and function in selected cases thus improve the life quality of the patients.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
北大核心
2015年第6期513-517,共5页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
甲状腺
癌
喉
气管
修复
thyroid gland
carcinoma
larynx
trachea
defect
