| Objective: To investigate the effect of vocal cords reconstruction with the vertical anterior laryngectomy and sternohyoid flap.Methods:1.The clinical data of 43 cases of laryngeal laryngeal carcinoma in the first affiliated Hospital of Guangxi Medical University in August 2014-April2017 were analyzed retrospectively,according to the mode of operation and the mode of laryngeal function reconstruction,the vocal cord reconstruction group and the non reconstruction group were divided into Reconstruction Group 20 Routine laryngeal vertical anterior resection of the ring epiglottis or tongue anastomosis pedicled sternum hyoid muscle flap reconstruction of the vocal cords,non-reconstruction Group(23)underwent partial excision of the epiglottis anastomosis of the cricoid,and observed the postoperative respiratory function(1 years after the removal rate of tracheal cannula)and swallowing function(the number of days for the removal of gastric tube),Pronunciation function(subjective evaluation),prognosis of 1 years after operation: complication,recurrence rate,survival rate,discuss the effect of partial laryngectomy with pedicled sternum flap;2,Electron laryngoscope Examination: Using Olympuselectronic nose and throat mirror to capture laryngoscope image in real time,analysis of the two groups of patients after the operation of the laryngeal Spiral CT scan,and then selected 20 cases of the same age,a normal person with no throat disease.Spiral CT scanning of the larynx,with the software of the imaging system,respectively,to measure the transverse diameter of the posterior glottis of the two groups of patients after operation and normal examination of the ladle cartilage plane(bilateral ladle cartilage reservation,After measuring the glottis transverse diameter of the two-side ladle cartilage and the unilateral ladle cartilage,the glottis transverse diameter of the side of the ladle cartilage was measured,the anterior and posterior diameter and the glottis area of the glottis area were measured,and the changes of glottis morphology in the vocal cord reconstruction group were observed with the laryngoscope analysis.4,the use of SPSS20.0 statistical analysis,measurement data using T-Test,counting data using X2 Test,p<0.05 for the difference has a statistical significanceResults:(1)the two groups of patients were all survived during the follow-up period.There were 1 cases of recurrence in the non reconstruction group and no recurrence(2)in the reconstruction group: 3 cases in the reconstruction group had complications,including 2 cases of glottic growth of granulation tissue,1 cases of larynx fistula,and 2 cases of inhalation pneumonia after the non reconstruction group.(3)the removal rate of tracheal cannula and the quality of gastric tube extraction and pronunciation in 1 years after operation:the removal rate of tracheal cannula 1 years after operation in two groups The Study group: 13.2±2.8 days,the control group of gastric tube extraction time:16.6±5.3 days,statistically analyzed t=-2.652,p<0.05,statistically significant;two groups of patients pronounced in accordance with the Marching [1]Pronunciation evaluation criteria,the reconstruction group pronounced good 10 cases,medium 6 cases,the difference of 4 cases,the non-reconstructed group was pronounced well in 4 cases,medium 14 cases,5 cases,two groups of pronunciation in the middle and above,by statistical analysis,x2=0.02,p>0.05,no statistical significance,the two groups of good pronunciation compared,x2=5.18,p<0.05,statistically significant;(4)The reconstruction group has a transverse diameter of 12.52 ±2.39 mm,the lateral diameter of the reconstructed group was: 13.13±1.97 mm,the normal inspector’s transverse diameter was:12.70±1.07 mm,the transverse diameter of the reconstructed group was compared with that of the normal inspector: t=-0.246,p>0.05,no statistically significant,and the transverse diameter of the non-reconstructed group was compared with that of the normal inspector: t= 0.736,p>0.05,no statistically significant,reconstruction group and non-reconstruction group transverse diameter comparison: t=-0.708,p>0.05,no statistical significance;the reconstruction group was 16.31±1.92 mm,and the anterior and posterior diameter of the reconstructed group was 17.15±1.25 mm,The normal inspectors were 20.49±0.90 mm,and the anterior and posterior diameters of the reconstructed group were compared with those of normal inspectors: t=-7.209,p<0.05,statistically significant,compared with the anterior and posterior diameters of the non-reconstructed group and the normal inspector:t=-8.190,p<0.05,statistically significant,the anterior and posterior diameters of the reconstructed group and the non reconstructed group were compared: t=-0.708,p>0.05,no statistical significance;the area of glottis area of reconstruction Group is: 1.71±0.10cm2,the area of non reconstruction group is2.09±0.13cm2,The normal inspector area is: 1.94±0.09CM2,the Reconstruction group area and the normal inspector compare t=-5.81,p<0.05,have the statistical significance,the non reconstruction group area compared with the normalinspector: T= 3.547,p<0.05,has the statistical significance,the reconstruction group and the Non reconstruction Group area comparison: t=-7.902,p<0.05,statistically significant.(5)The shape of glottis: Combined with Laryngoscope,the two groups showed different degree of swelling,the shape of glottis area in the reconstructed group was approximately triangular,and the glottis was mainly rounded after the reconstruction group.Conclusion: the reconstruction of the vocal cords of the sternum and hyoid muscle flap of the annular epiglottis or ring tongue anastomosis with the vertical anterior larynx(1)the survival rate,the extubation rate of the trachea cannula is high,the function of swallowing and pronunciation is well restored,and it can improve the quality of life of the patients.(2)compared with the normal glottis,the anterior and posterior diameter and area are reduced and the transverse diameter is not.Obviously,compared with non glottic reconstruction,there was no significant difference in anteroposterior diameter and transverse diameter,and the area decreased.Glottal morphology was approximately triangles. |
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