CAJ | 학술논문

目的：探讨喉癌喉部分切除术后喉功能重建的恢复情况。方法从2007年1月到2014年12月共有92例喉癌喉部分切除术后喉功能重建的患者，回顾其术后气管套管拔除及时间、胃管拔除时间、发音功能、并发症及生存情况（复发、转移、死亡）等资料。分析4种主要修复方法对喉功能重建的恢复情况的影响。结果应用残余黏膜、肌筋膜瓣、带状肌瓣、颈部皮瓣4种主要修复方法患者共81例，均为男性，年龄因素组间比较，F＝0．603，P＝0．615＞0．05，差异没有统计学意义，其他方法数量少，未予比较。4种主要修复方法拔除气管套管时间有差异，差异有统计学意义（F＝5．465，P＝0．002＜0．05），以颈部皮瓣组最差。4种主要修复方法对胃管拔除时间影响有差异，差异有统计学意义（F＝3．227，P＝0．027＜0．05），以带状肌瓣组与颈部皮瓣组恢复较慢。4种主要修复方法的发音效果无差异（χ2＝1．025，P＝0．795＞0．05）。残余黏膜组2周内拔管33例，拔管率86．8％；肌筋膜瓣组2周内拔管10例，拔管率76．9％；带状肌瓣组2周内拔管9例，拔管率69．2％；颈部皮瓣组2周内拔管8例，拔管率47．1％。残余黏膜组1周内拔除胃管25例，拔管率74．1％；肌筋膜瓣组1周内拔除胃管8例，拔管率61．5％；带状肌瓣组1周内拔除胃管4例，拔管率30．8％；颈部皮瓣组1周内拔除胃管6例，拔管率35．3％。术后喉功能恢复效果无差异，P＞0．05。结论喉部分切除术后喉结构和功能的修复与重建是喉部分切除术中的关键，选择合理的术式和修复材料影响患者的生存质量及生存率。应用残余黏膜、肌筋膜瓣、带状肌瓣、颈部皮瓣等组织修复喉缺损，喉功能恢复良好。
목적：탐토후암후부분절제술후후공능중건적회복정황。방법종2007년1월도2014년12월공유92례후암후부분절제술후후공능중건적환자，회고기술후기관투관발제급시간、위관발제시간、발음공능、병발증급생존정황（복발、전이、사망）등자료。분석4충주요수복방법대후공능중건적회복정황적영향。결과응용잔여점막、기근막판、대상기판、경부피판4충주요수복방법환자공81례，균위남성，년령인소조간비교，F＝0．603，P＝0．615＞0．05，차이몰유통계학의의，기타방법수량소，미여비교。4충주요수복방법발제기관투관시간유차이，차이유통계학의의（F＝5．465，P＝0．002＜0．05），이경부피판조최차。4충주요수복방법대위관발제시간영향유차이，차이유통계학의의（F＝3．227，P＝0．027＜0．05），이대상기판조여경부피판조회복교만。4충주요수복방법적발음효과무차이（χ2＝1．025，P＝0．795＞0．05）。잔여점막조2주내발관33례，발관솔86．8％；기근막판조2주내발관10례，발관솔76．9％；대상기판조2주내발관9례，발관솔69．2％；경부피판조2주내발관8례，발관솔47．1％。잔여점막조1주내발제위관25례，발관솔74．1％；기근막판조1주내발제위관8례，발관솔61．5％；대상기판조1주내발제위관4례，발관솔30．8％；경부피판조1주내발제위관6례，발관솔35．3％。술후후공능회복효과무차이，P＞0．05。결론후부분절제술후후결구화공능적수복여중건시후부분절제술중적관건，선택합리적술식화수복재료영향환자적생존질량급생존솔。응용잔여점막、기근막판、대상기판、경부피판등조직수복후결손，후공능회복량호。
Objective To observe the restoration of laryngeal coloboma part during laryngeal function reconstruction in laryngocarcinoma patients after partial laryngectomy.Methods Postoperative respiratory function( time when tracheal tube pul-ling up) ,swallowing function( time when stomach tube pulling up,aspiration) ,phonic function,complications and survival situa-tion( relapse,transfer,death) of 92 cases of laryngocarcinoma patients treated with partial laryngectomy and laryngeal function re-construction were analyzed.The effect of 4 major repair methods on laryngeal function reconstruction were analyzed.Results 81 male patients received 4 major repair methods including residual mucosa,myofascial flap,banded muscle and neck flap,there had no significant difference in age among the 4 groups (F=0.603,P=0.615>0.05).9 cases treated with other therapeutic method were not compared because of number.There had significant difference among the 4 groups in the time when tracheal tube was pulled up (F=5.465,P=0.002<0.05),and that of the neck flap group was the worst.There had significant difference among the 4 groups in the stomach tube pulling up time (F=3.227,P=0.027<0.05),and that of the banded muscle and neck flap was slower,but the phonic function among 4 groups has no significant difference(χ2 =1.025,P=0.795>0.05) .The decannula-tion rate within 2 weeks was 86.8%(33 cases) in residual mucosa group,76.9%(10 cases) in myofascial flap group,69.2%(9 cases) in banded muscle group and 47.1%(8 cases) in neck flap group.The pull out stomach tube rate within 1 week was 74.1%(25 cases) in residual mucosa group,61.5%(8 cases) in myofascial flap group,30.8%(4 cases) in banded muscle group and 35.3%(6 cases) in neck flap group.There had no significant difference in pronunciation(P>0.05).Conclusion Restoration of laryngeal coloboma part during laryngeal function reconstruction in laryngocarcinoma patients after partial laryngec-tomy was the important factors,reasonable operation method and repair material can affect the quality of life and survival rate of patients.Residual mucosa,myofascial flap,banded muscle and neck flap for laryngeal defect tissue repairing are effective.