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目的 探讨双蒂双肌瓣在晚期喉癌切除、喉功能重建中的应用及远期疗效。方法 1991— 1995年对 312例喉癌 T3、T4病变行扩大部分喉切除 ,应用单侧或双侧双蒂双肌瓣修复喉腔 ,重建喉功能。其中男 2 87例 ,女 2 5例。声门上型 2 2 6例 ,声门型 72例 ,声门下型 14例。术式包括 :扩大声门上水平部分喉切除术 ,扩大垂直部分喉切除术 , 喉切除及次全喉切除术。结果 3年生存率 78.2 % (2 44 / 312 ) ,5年生存率 5 6 .7% (10 4/ 2 89) ,喉功能恢复情况 :总拔管率为 5 4.8% (171/ 312 )。其中扩大声门水平喉拔管率为 76 .6 % (98/ 12 8) ,扩大垂直喉拔管率为 42 .9% (40 / 93) ,次全喉切除拔管率 36 .3% (33/ 91)。吞咽功能在 7～ 10 d后恢复 ,无呛咳。发声功能良好。结论 该术式的应用 ,扩大了喉部分切除的适应证 ,提高了生存质量及生存率 ,并发症少
Objective To investigate the application of double pedicled double muscle flap in the treatment of advanced laryngeal carcinoma and reconstruction of laryngeal function and its long-term curative effect. Methods From 1991 to 1995, 312 laryngeal cancer patients with T3 and T4 lesions were extended to partial laryngectomy, and the laryngeal cavity was repaired by unilateral or bilateral double pedicled double muscle flap to reconstruct laryngeal function. There were 2 87 males and 25 females. 262 cases of supraglottic, 72 cases of glottis, 14 cases of subglottic. Procedures include: the expansion of the supraglottic partial laryngectomy, to expand the vertical part of the laryngectomy, laryngectomy and subtotal laryngectomy. Results The 3-year survival rate was 78.2% (2 44/312), the 5-year survival rate was 56.7% (104/289). The recovery of laryngeal function was: 5 4.8% (171 of 312). Among them, the rate of expanding laryngotracheal tube was 76.6% (98/128), the rate of expanding vertical laryngotracheal tube was 42.9% (40/93), the rate of subtotal laryngectomy was 36.3% ( 33/91). Swallowing function recovered after 7 ~ 10 d, no cough. Vocal function is good. Conclusion The application of this technique expands the indications of partial laryngectomy and improves the quality of life and survival rate with fewer complications