闭合器在全喉全切术中的临床应用研究(1)
【摘要】 目的：探讨闭合器在全喉全切术中的临床应用。方法：选取2016年1月-2018年6月本院收治的喉癌患者共60例，按照随机数字表法分为观察组(n=30)和对照组(n=30)，观察组给予全喉切除后闭合器吻合，对照组给予全喉切除术后手工吻合。比较两组手术时间、术后康复情况及术前和术后1个月生活质量情况。结果：观察组手术时间显著短于对照组，咽瘘发生率显著低于对照组，差异均有统计学意义(P<0.05)。术后1个月两组物质生活评分、躯体健康评分、心理健康评分、社会功能评分均显著高于术前，且观察组各评分均显著高于对照组，差异均有统计学意义(P<0.05)。结论：闭合器可以节省全喉全切术的手术时间，降低咽瘘发生率，改善患者术后生活质量，临床应用效果确切。
【关键词】 闭合器 全喉全切术 喉癌
[Abstract] Objective： To explore the clinical application of closure device in total laryngectomy. Method： A total of 60 patients with laryngeal cancer admitted to our hospital from January 2016 to June 2018 were selected and divided into the observation group (n=30) and the control group (n=30) according to random number table method. The observation group was given closure device anastomosis after total laryngectomy， while the control group was given manual anastomosis after total laryngectomy. The operation time， postoperative rehabilitation， and the quality of life before and 1 month after operation of two groups were compared. Result： The operation time of the observation group was significantly shorter than that of the control group， and the incidence of pharyngeal fistula was significantly lower than that of the control group， the differences were statistically significant (P<0.05). The material life score， physical health score， mental health score and social function score of two groups 1 month after operation were significantly higher than those of before operation， and the observation group were significantly higher than those of the control group， the differences were statistically significant (P<0.05). Conclusion： Closure device can save the operation time of total laryngectomy， reduce the incidence of pharyngeal fistula， improve the quality of life after operation， and the clinical application effect is exact.
[Key words] Closure device Total laryngectomy Laryngeal cancer
First-author’s address： Ganzhou Cancer Hospital， Ganzhou 341000， China
doi：10.3969/j.issn.1674-4985.2019.34.032
喉癌作為一种多见的耳鼻喉科恶性肿瘤，病变主要来自喉黏膜上皮组织，且中老年男性居多[1-4]。该病以咳嗽、声音嘶哑以及呼吸吞咽困难为主要临床表现，其治疗主要依赖于手术疗法[5-8]。喉部全切后喉咽腔黏膜吻合的传统方法为手工吻合，耗时较久，而使用吻合器吻合方便快捷，且效果较好，深受临床青睐[9]。笔者对闭合器在全喉全切术中的临床应用进行探讨，现报道如下。
1 资料与方法
1.1 一般资料 选取2016年1月-2018年6月本院收治的喉癌患者共60例。纳入标准：均符合喉癌的诊断标准，且均经病理结果证实[10];病变仅局限于喉内。排除标准：伴有严重呼吸、消化、神经、泌尿以及肝肾功能等其他系统性障碍。按照随机数字表法分为观察组(n=30)和对照组(n=30)，本研究已经医院伦理学委员会批准，患者知情同意并签署知情同意书。
1.2 方法 观察组患者给予全喉切除后闭合器吻合：皮纹切口19例，T型切口11例。先将颈阔肌皮瓣依次切开并后翻，再逐渐使喉骨骼化脱离出来;在双侧甲状腺软骨外骨膜下使用小剥离子将梨状窝外壁黏膜剥离;后将甲状腺峡部切断，使气管、食管游离，并切断气管(4～5环间)，将食管间组织和气管膜部分离;使用双钩或Allis钳从气管内将会厌下拉、喉上提，再将喉标本采用直线闭合器整块水平切除。取离体标本边缘做冰冻切片送检，并确认切片阴性。造瘘气管，充分止血，负压引流，对位缝合舌骨上下肌肉，最后将术腔依次缝合。使用闭合器将需要闭合的咽腔黏膜均匀夹闭，再扣紧，在闭合的咽腔黏膜内钉入闭合钉，后松开闭合器，吻合口呈水平线型即可。对照组给予全喉切除术后手工吻合：皮纹切口16例、T型切口14例。将喉体骨骼化脱出，然后完整切除，后内翻缝合，给予气管造瘘，充分止血，负压引流，封闭咽腔。, 百拇医药(罗克勍 田克强 肖富福 谢鋆晖 蓝小林)
【关键词】 闭合器 全喉全切术 喉癌
[Abstract] Objective： To explore the clinical application of closure device in total laryngectomy. Method： A total of 60 patients with laryngeal cancer admitted to our hospital from January 2016 to June 2018 were selected and divided into the observation group (n=30) and the control group (n=30) according to random number table method. The observation group was given closure device anastomosis after total laryngectomy， while the control group was given manual anastomosis after total laryngectomy. The operation time， postoperative rehabilitation， and the quality of life before and 1 month after operation of two groups were compared. Result： The operation time of the observation group was significantly shorter than that of the control group， and the incidence of pharyngeal fistula was significantly lower than that of the control group， the differences were statistically significant (P<0.05). The material life score， physical health score， mental health score and social function score of two groups 1 month after operation were significantly higher than those of before operation， and the observation group were significantly higher than those of the control group， the differences were statistically significant (P<0.05). Conclusion： Closure device can save the operation time of total laryngectomy， reduce the incidence of pharyngeal fistula， improve the quality of life after operation， and the clinical application effect is exact.
[Key words] Closure device Total laryngectomy Laryngeal cancer
First-author’s address： Ganzhou Cancer Hospital， Ganzhou 341000， China
doi：10.3969/j.issn.1674-4985.2019.34.032
喉癌作為一种多见的耳鼻喉科恶性肿瘤，病变主要来自喉黏膜上皮组织，且中老年男性居多[1-4]。该病以咳嗽、声音嘶哑以及呼吸吞咽困难为主要临床表现，其治疗主要依赖于手术疗法[5-8]。喉部全切后喉咽腔黏膜吻合的传统方法为手工吻合，耗时较久，而使用吻合器吻合方便快捷，且效果较好，深受临床青睐[9]。笔者对闭合器在全喉全切术中的临床应用进行探讨，现报道如下。
1 资料与方法
1.1 一般资料 选取2016年1月-2018年6月本院收治的喉癌患者共60例。纳入标准：均符合喉癌的诊断标准，且均经病理结果证实[10];病变仅局限于喉内。排除标准：伴有严重呼吸、消化、神经、泌尿以及肝肾功能等其他系统性障碍。按照随机数字表法分为观察组(n=30)和对照组(n=30)，本研究已经医院伦理学委员会批准，患者知情同意并签署知情同意书。
1.2 方法 观察组患者给予全喉切除后闭合器吻合：皮纹切口19例，T型切口11例。先将颈阔肌皮瓣依次切开并后翻，再逐渐使喉骨骼化脱离出来;在双侧甲状腺软骨外骨膜下使用小剥离子将梨状窝外壁黏膜剥离;后将甲状腺峡部切断，使气管、食管游离，并切断气管(4～5环间)，将食管间组织和气管膜部分离;使用双钩或Allis钳从气管内将会厌下拉、喉上提，再将喉标本采用直线闭合器整块水平切除。取离体标本边缘做冰冻切片送检，并确认切片阴性。造瘘气管，充分止血，负压引流，对位缝合舌骨上下肌肉，最后将术腔依次缝合。使用闭合器将需要闭合的咽腔黏膜均匀夹闭，再扣紧，在闭合的咽腔黏膜内钉入闭合钉，后松开闭合器，吻合口呈水平线型即可。对照组给予全喉切除术后手工吻合：皮纹切口16例、T型切口14例。将喉体骨骼化脱出，然后完整切除，后内翻缝合，给予气管造瘘，充分止血，负压引流，封闭咽腔。, 百拇医药(罗克勍 田克强 肖富福 谢鋆晖 蓝小林)