喉垂直式部份切除後的聲門重建手術—實驗研究

Glottic Reconstruction Following Vertical Partial Laryngectomy - An Experimental Research

朱本元(Pen-Yuan Chu) ； 張學逸(Shyue-Yih Chang)

《中華民國耳鼻喉科醫學會雜誌》 30卷2期 (1995/04) Pp. 138-144

https://doi.org/10.6286/1995.30.2.138

摘要

喉垂直式部份切除，對於早期聲門癌的治療，扮演著一個重要的角色。一個理想的手術，除了要完全切除癌症病灶外，喉部的重建亦須達成三個目標：1)維持一個通暢的呼吸道；2)避免吞嚥時有哽嗆的現象；3)重建接近正常的音聲機能。其中，手術後重建理想的音聲機能，是這種手術最難之處，也是決定手術方法優劣的關鍵。過去我們對於早期聲門癌病患，適用喉垂直式部份切除者，多選擇以胸舌骨肌瓣或會厭軟骨瓣進行喉部重建，但是這些仍有術後音聲機能恢復不穩定或不理想的情形。為解決此問題，我們設計了一個新的重建手術方法，這種手術主要是以舌骨大角及其內側的組織黏膜和舌骨下肌肉的複合組織瓣進行喉部重建。
我們使用10隻狗做喉垂直式部份切除及上述重建手術實驗，手術3個月後利用已建立的喉機能活體動物實驗模式及全器官組織切片(whole organ section)方法，，做客觀的分析與評估。初步的結果顯示，以此複合組織瓣進行喉部重建的狗，其存活的情形良好，也能得相當穩定的聲門重建效果，吞嚥及呼吸功能的恢復亦理想。不過如何擴充手術的適應症以及減低手術的複雜性，仍舊是我們進一步努力探討的目標。

關鍵字

喉垂直式部份切除 ； 聲門重建

並列摘要

Vertical partial laryngectomy plays an important role in the treatment of early glottic cancer. An ideal surgery must eradicate the concerous tissue completely and reconstruct to attain three goals: maintaining a patent airway, avoiding aspiration during swallowing, and restoring nearly normal vocal function. Among these goals, it is the most difficult to restore satisfactory vocal function. There are many kinds of glottic reconstruction after vertical partial laryngectomy, such as the sternohyoid flap and epiglottic flap that we have used in the glottic reconstruction. However, they still have the problem of unstable vocal function recovery. To resolve this problem, a new method of glottic reconstruction is designed. It uses the greater horn of the hyoid bone, medial wall mucosa of the hyoid bone and infra-hyoid muscles as the pseudocord..
In our experiment, 10 dogs received vertical partial laryngectomy and were reconstructed with above method. Three months after operation, the laryngeal functions were evaluated with in vivo canine phonatory model. Whole organ section was also done following functional evaluation. The preliminary results revealed good survival rate in the subject dogs. The ideal swallowing function and patent airway were achieved. The stable phonatory function was also achieved due to stable structure and good survival of the flap. However, how to expand the surgical indications and reduce the complexity of reconstruction still need further study.

並列關鍵字

vertical partial laryngectomy ； glottic reconstruction