SU1627151A1 - Method for surgical treatment of laryngopharyngeal carcinoma - Google Patents

Abstract

The invention relates to medicine, namely, restorative surgery of the ENT. organs. The purpose of the invention is the simultaneous restoration of the food-conducting function. The goal is achieved by closing the hypopharyngeal defect with a flap from the medial leg of the spermus muscle. A positive effect is evaluated by an improvement in functional results.

Description

FIELD OF THE INVENTION The invention relates to medicine, namely to restorative surgery of the ENT. organs.

The aim of the invention is the simultaneous restoration of the food-conducting function.

The method is carried out as follows.

The patient undergoes a horizontal resection of the larynx with extensive resection of the hypopharynx, larynx, gums, removal of the muscles of the anterior surface of the neck, which are included in the block. The resulting defect is partially narrowed due to the laryngopharyngeal walls. The remaining defect, 6X4 cm in size, is covered with a mobilized muscle flap, cut from the medial regions of the lower third of the sternum muscle, pointing up to the middle third and displaced at an angle of 90 ° to the edges of the defect without tension. A rubber pendant is inserted into the laryngeal lumen.

A separate knotted stitches to the edges of the defect along the entire perimeter of the hypopharynx hem a muscle flap from a sieve of sternum. The suture line is covered with separate sutures by using the muscles of the floor of the mouth and the upper surface of the flap. In the future, the wound is sutured tightly. Aspiration drainage is supplied to the operating bed.

The proposed method of closing the hypopharynx with combined horizontal resection of the larynx was applied in four patients. In all patients, healing occurred by primary tension. Pisheprovod- to function was compensated in the period from 2 to 3 weeks after surgery. The term decantation is from 2 weeks to 2.5 months.

Example. Patient K., 1950 g.

Patient for cancer of the lamella of the larynx IV degree. (T4NoMo), confirmed by histological examination (squamous non-squamous cancer), combined treatment was performed. At the first stage, radiation treatment in HBO SOD-23, 1 Gy. on the biological equivalent of 30 Gy. At the second stage 13 11.87, a horizontal resection of the larynx was performed. 01/14/88 Preventive surgery performed on lymphocyte x neck to the left. In early March 1988, a patient was diagnosed with a relapse of a clinically cancer in the area of the right valeokula and the pharyngeal-epiglottic fold in the form of infiltration and metastases to the lymph nodes of the neck on the right. 03/24/88 was held

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operation of the Krail type on the right with preservation of the squatus muscle and ligation of the internal celiac vein and repeated expanded combined resection of the larynx, requiring the addition of remnants of the dorsal subdivision section and predorotral tissue, the paw bone, the anterior neck muscles covering the thyroid chromium, significant covering resection of the root of the tongue and the medial, outer and anterior wall of the hypopharynx on the right, which led to the formation of an extensive defect of the hypopharynx and larynx with dimensions of 8X6 cm.

Mobilization of the cord and laryngopharynx was difficult due to the significant amount of resection and cicatricial changes after the first operation. Broad language mobilization failed due to the possibility of damage to the vasculature of the lingual nerves. In similar operations, a pharyngolaringostomy was widespread, which made it impossible to restore the food-conducting function.

According to the proposed method, the laryngopharyngeal defect was closed as follows: first, the defect was partially narrowed without tension from the sides due to mobilization of the walls of the pharynx and tongue to sizes 6X5 cm. Muscular flap containing its entire thickness was cut from the medial part of the lower third of the sternum muscle by cutting it off fixation points to the clavicle and sternum, excretion up to the middle third upwards so as not to damage the nutritional vascular pedicle; The flap is rotated 90 ° and loosely laid over the laryngopharyngeal defect without tension in the transverse The direction, completely covering it. Introduced "pendant

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into the nasoesophageal probe. By separate knotted sutures, the muscle flap along the entire perimeter is hemmed to the edges of the hypopharyngeal defect without tension. Submersible seams.

The postoperative course without features. Wound healing by primary tension. Nasoesophageal probe removed on the 16th day. Separating and food handling functions are compensated.

The proposed laryngopharyngeal plastic technique allows one-step restoration of the food-conducting pharyngeal function after surgeries for common laryngopharyngeal tumors with muscle pulping due to the pedicle of the civagus muscle, which is impossible using standard methods for closing surgical defects of the pharyngeal pharynx. Postoperative complications are reduced due to adequate blood supply. but a muscle flap. Reconstruction of the pischprovodnoy tract by creating a muscle pulp can compensate for the gastrointestinal function of the pharynx and the laryngeal separation function and shorten the rehabilitation of patients.

Claims (1)

Invention Formula A method of surgical treatment of laryngopharyngeal cancer by resection of the cord, anterior muscles of the neck, horizontal resection of the larynx, followed by closure of the anterior wall of the laryngopharynx, characterized in that. In order to simultaneously restore pishcheprovodnoy function, the laryngopharyngeal defect is closed with a flap from the medial leg of the squatum.