RU2323691C2 - Method of reconstructive laryngectomy with forming planned functional pharyngostoma in patients with local larynx cancer with localisation in fold and subglottidean fold - Google Patents

Abstract

FIELD: medicine, ENT-oncology.

SUBSTANCE: laryngectomy with the following planned pharyngostoma is invented. In this technique, skin incision is made arcwise, based at hyoid bone level, with convexity turned towards mental area, then left arc end is continued by vertical paramedian incision to tracheostome level. During separating larynx, long neck muscles are preserved, namely sternohyoid and omohyoid, as well as hyoid bone, except for periosteum, which is exfoliated and removed together with ante-epiglottic cavity. After tissues are removed, tunnel is formed above hyoid bone by dissecting medial fascicles of mylohyoid muscle and geniohyoid muscle. Pharyngostoma is formed and its lower edge is formed by throwing arch-shaped skin flap that was resulted from skin incision, over upper edge of hyoid bone and fixing it to pharynx edges, and mucous of tongue root is fixed to upper edge of arch-shaped incision in mental area, so as to form upper edge of pharyngostoma.

EFFECT: efficacy of treatment is increased as well as patients' functional rehabilitation.

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Description

The invention relates to medicine, specifically to oncology, and relates to methods for treating patients with locally spread operable forms of cancer of the laryngeal mucosa with localization in the area of the fold and sub-fold sections of the larynx.

Known methods for treating patients with locally spread operable forms of cancer of the laryngeal mucosa with localization in the area of the fold and subglottic sections of the larynx, including surgery in the form of laryngectomy (Tumors of the head and neck, A.I. Pases, M. Medicine, 2000).

However, the method is ineffective and causes a large number of complications.

The closest to the achieved positive result (prototype) is a method of surgical treatment of patients with locally advanced forms of tumors of the laryngeal mucosa with localization in the area of the fold and sub-fold sections of the larynx, including surgery in the form of a laryngectomy with opening the larynx of the pharynx, performing larynx removal under the control of vision with the formation of planned farkngostomy (Tumors of the head and neck, A.I. Paches, M.Meditsina, 2000).

However, the known method is ineffective and does not allow subsequently to carry out a full functional rehabilitation of patients, having restored not only the function of swallowing, but also breathing through the natural paths, that is, not through the tracheostomy, but through the newly recreated breathing tube.

The authors propose a new effective method for treating patients with locally advanced forms of laryngeal mucosal tumors with localization in the area of the fold and subglottal part of the larynx, which consists in performing reconstructive laryngectomy with the formation of a planned functioning pharyngostomy.

The aim of the invention is to increase the effectiveness of treatment and primary functional rehabilitation of patients.

This goal is achieved by the fact that according to the method of treating patients with operable locally advanced forms of tumors of the laryngeal mucosa with localization in the area of the fold and sub-fold sections of the larynx, at the first stage of combined treatment, reconstructive laryngectomy is performed with the formation of a planned functioning pharyngostomy.

What is new in the invention is that at the first stage of surgical intervention, a modified skin incision is made in the form of an arch located at the base of the hyoid bone with the convex side facing the chin, then the left end of the arch continues into a vertical paramedian incision that goes up to the level of the tracheostomy. The formed flap is separated, exposing the larynx and adjacent anatomical structures of the neck. Then, a reconstructive laryngectomy is performed, the peculiarity of which is the preservation of the long front muscles of the neck, namely the sternum-hyoid and scapular-hyoid, which do not intersect, but are diverted to the sides, preserving their points of anatomical fixation. The hyoid bone does not enter the removed tissue block, but the periosteum is exfoliated from it and, together with the pre-epiglottis space, enters the removed tissue block. The muscles of the tongue do not cut off completely from the hyoid bone. The drug is removed in the usual way, while the larynx is cut off from the trachea, the pharynx is opened and, under the control of vision, the drug is removed from the bottom up. Over the body of the hyoid bone, the medial bundles of the jaw-hyoid muscle and the chin-hyoid muscle are excised to the level of discharge of the small horns of the hyoid bone. A triangular tunnel is formed, extending to the root of the tongue. An arched skin flap formed during a skin incision is thrown over the upper edge of the hyoid bone, fixed to the edges of the pharynx. The lower edge of the planned functioning pharyngostomy is formed. The mucous root of the tongue is fixed to the upper edge of the arched skin incision in the chin region, forming the upper edge of the functioning pharyngostomy.

At the same time, a pharyngostomy gaping is observed in a calm state, and at the time of the pharynx, due to the contraction of the muscles attached to the hyoid bone, the upper and lower edges of the pharyngostomy are closed and there is no contact of food masses on the front surface of the neck.

The invention meets the criteria of "novelty", since it is not known from the prior art, "inventive step", since it does not explicitly follow for a specialist, "industrial applicability", since it can be successfully used in oncology.

A clinical example of the method:

Patient L. Lyashenko, 53 years old, male, has been treated in the department of head and neck tumors since November 24, 2003, Case history No. 24209. Diagnosis: Cancer of the mucous membrane of the middle section of the larynx T3N0M0. Histological diagnosis No. 3965/3, December 4, 2003 - highly differentiated squamous keratinizing cancer. Objectively, before the start of treatment, the patient had an exophytic tumor of the growth form that occupied the vocal fold on the right with the transition to the posterior and anterior commissures and the anterior third of the vocal fold on the left, immobility of the right half of the larynx was noted.

On December 8, 2003, a reconstructive laryngectomy was performed with the formation of a planned functioning pharyngostomy. In the postoperative period, healing proceeded by primary intention. On the 14th day, the nasophageal probe was removed, nutrition was natural. There is a good functioning of the pharyngostomy, no ingestion of food masses on the front surface of the neck.

From 6.01.2004 to 5.02.2004, a course of postoperative radiation therapy with classical fractionation was carried out, ROD 2 Gy to SOD 42 Gy.

At the time of the control examination (02/14/2006), there are no signs of tumor recurrence. The pharyngostoma functions, nutrition is carried out naturally.

According to the proposed method, a total of 12 patients received treatment. The clinical study included 12 men aged 45 to 70 years. All patients had common forms of tumors III tbsp. with localization in the area of the folding and sub-folding sections of the larynx. All patients underwent reconstructive laryngectomy with the formation of a planned functioning pharyngostomy. In 10 out of 12 patients (83.3%), a stable functioning of the pharyngostomy was achieved, nutrition is carried out naturally. None of the patients recorded progression or relapse of the tumor.

Claims (1)

A method of treating patients with operable forms of cancer of the laryngeal mucosa with localization in the region of the middle and subglottic sections of the larynx, including laryngectomy with the formation of a planned pharyngostomy, characterized in that a skin incision is made in the form of an arc located at the base of the hyoid bone, the convex side facing the chin areas, then the left end of the arch continues into a vertical paramedian incision, going to the level of the tracheostomy, while during the allocation of the larynx retain long neck muscles, namely the sternum-hyoid and scapular-hyoid, as well as the hyoid bone, from which the periosteum is peeled off and, together with the pre-epiglottis space, is included in the block of removed tissues, the preparation is removed, after which a tunnel is formed over the body of the hyoid bone by excision of the medial bundles jaw-hyoid muscle and chin-hyoid muscle, make a pharyngostoma, while its lower edge is formed by throwing an arched skin flap formed during a skin incision through the upper the first edge of the hyoid bone and fixing it to the edges of the pharynx, and the mucosa of the root of the tongue is fixed to the upper edge of the arcuate skin incision in the chin, forming the upper edge of the pharyngostomy.