喉近全切除术治疗晚期喉癌的临床疗效观察

目的 探讨晚期喉癌患者喉切除术后保留喉发声功能以提高生存质量,方法 对１７例晚期喉癌行喉近全切除术（Ｐｅａｒｓｏｎ手术）手术中,保留一侧杓状软骨及一条宽约１．５ｃｍ的与气管相连的粘膜条形成发声管,Ｎ０期患者规探查颈动脉分叉处淋巴结,根据冰冻病检结果而决定是否行颈淋巴清扫术,结果：术后１２例发声良地,除１例外均无明误吸现象,２年,３年及５年生存率分别为７０．６％,６２．４％,５０％,结论：Ｐｅａｒｓ     

会厌在喉部分切除喉功能重建术中的应用

目的 探讨会厌在喉部分切除喉功能重建术中的应用价值。方法 １９９２年１２月－１９９６年１月３２例不同分期的声门型,声门上型喉癌行喉部分切除术,将残存会厌下移保留喉功能。结果 ２１例声门型喉癌术后１９例拔除气管套管恢复喉的全部功能,１１例声门上型喉癌５例恢复喉全部功能,并于术后１４－１８ｄ恢复吞咽功能,无１例出现误吸收起严重并发症。３年生存率８７．５％（２８／３２）,５年生存率５８．３％（７／１２）     

高龄喉癌患者的功能保全性手术治疗

目的：探讨功能保全性手术在高龄喉癌患者治疗中的应用。方法：回顾分析71例70岁以上喉癌患者的临床资料，其中行喉声门上水平部分切除术4例，喉裂开声带切除术11例，喉垂直部分切除术18例，喉扩大垂直部分切除术11例，喉环状软骨上部分切除术2例，喉次全切除会厌成形术25例，同时行颈清扫术27例。结果：71例均恢复发声功能和吞咽保护功能，拔管率为66．20％；3年生存率为66．04％，5年生存率为47．06％；无严重并发症发生。结论：在正确掌握适应证、充分做好围手术期处理的务件下，高龄喉癌患者的喉功能保全是可行的。     

老龄喉癌喉部分切除术远期疗效观察

目的探讨老龄喉癌患者行保留喉功能切除手术的远期疗效。方法总结１９８６～１９９６年间９９例６５岁以上老龄喉癌患者行各种喉部分切除术的临床资料,其中声带切除１４例、垂直半喉切除３１例、声门上水平半喉切除１５例、声门水平切除２例、水平垂直（３／４）切除２２例、喉近全切除５例、喉全切除环咽吻合１０例。结果术后全部病例均恢复了发音功能及吞咽功能,拔管率为９１．９％。术中无死亡,术后无严重并发症。３、５年生存率分别为７６．７％、７５．５％。结论老龄不是保留喉功能手术的禁忌证,关键是正确掌握各种术式的适应症及提高外科手术技巧减少术后并发症。     

手术加放射治疗与单纯喉部分切除术治疗喉癌的疗效比较

目的 探讨手术加放射治疗能否比单纯部分喉手术提高疗效。方法 １７１例喉癌随机分为单纯手术,手术加术后放射治疗（剂量５１－７０Ｇｙ）和放射治疗加手术（剂量４０－５０Ｇｙ）３组,前瞻性观察各组的治疗效果。术式包括：声带切除术,垂直半喉切除术,水平半喉切除术,次全喉切除术。结果 单纯手术组（５６例）,手术加术后放射治疗组（６５例）和术前放射治疗加手术组（５０例）的５年生存率分别为８５．７％（４２／４９）     

老龄喉癌患者喉近全切除术远期疗效观察

目的：探讨老龄喉癌患者行喉近全切除术的远期疗效。方法：对12例65岁以上喉癌患者行喉近全切除术，在Pearson手术基础上，保留部分环状软骨板、环杓关节及喉返神经。结果：3、5年生存率为75．0％及66．7％。术后2周内全部恢复吞咽功能。10例获得理想发声，2例发声失败。结论：对于有心、肺、脑等基础疾病的老龄喉癌患者，喉近全切除术是一种较好的方法。     

喉部分切除术的临床评价

对资料完整的１３５例喉部分切除术的喉癌患者进行了疗效分析，３、５年生存率分别为８６．７％和８３．８％。Ⅰ和Ⅱ期的３、５年生存率为９３．８％和９０．６％，高于Ⅲ和Ⅳ期（７６．４％，７０．４％）；声门区癌３、５年生存率（９０．５％，８７．７％）高于声门上区（７３．３％，６６．７％）。局部复发１４例，颈部转移１１例，远处转移２例，１４例行再次手术治疗，术后２年生存率为６４．３％。所有患者的发音功能均可保留，但受到不同程度的损害；６２．９％的患者术后有不同程度的误吸，经训练后大多可正常进食，只有１例需二次手术关闭喉口。７６．３％的患者可拔管，在已拔管的患者中有２１．４％诉有轻度呼吸不畅，但不影响日常工作。提出喉癌患者行喉部分切除术后的疗效评价应包括两个方面：肿瘤切除的彻底性（生存率）和喉功能恢复的程度。     

老龄喉癌喉部分切除术远期疗效观察

目的 探讨老龄喉癌患者行保留喉功能切除术的远期疗效。方法 总结１９８６￣１９９６年间９９例６５岁以上老龄喉癌患者行各种喉部分切降术的临床资料,其中声带切除４４例、垂直半喉切除３１例、声门上水平半喉切除１５例、声门水平切除２例、水平垂直（３／４）切除２２例、喉近全切除５例、喉全切除环咽吻合１０例。结果 术后全部病例均恢复了发音功能及吞咽功能,拔管率为９１．９％。术中无死亡,术后无严重并发症。３、５年     

喉部分切除喉功能重建术

目的探讨喉部分切除术治疗声门型、声门上型喉癌的疗效和功能恢复。方法对我院1992年7月--2003年8月间喉癌行喉部分切除喉功能重建术的32例（占同期喉癌手术59．2％）临床资料进行总结和随访。其中声门型喉癌23例，声门上型喉癌9例；行喉裂开声带切除术室带下移修复术5例，垂直喉部分切除带状肌修复14例。垂直喉部分切除会厌修复3例，扩大垂直喉部分切除环舌根会厌吻合术1例，声门上水平部分喉切除术7例，扩大声门上水平部分喉切除术舌根修复2例。结果1、3、5年生存率分别为96．9％（31／32）、87．0％（20／23）、72．2（13118）。总拔管率为90．6（29／32）。全部病例恢复经口进食，一经拔管均能发音。术后复发率为12．5％。结论喉部分切除术不仅是喉癌根治的有效术式，而且同时可以较好地保留喉的生理功能，提高患者术后的生活质量。     

112例T3期喉癌扩大喉部分切除和喉全切除术的疗效分析

目的：探讨Ｔ３期扩在喉部分切除和喉全切除术的疗效。方法“于１９８４年１月至１９９６年５月对１１２例Ｔ３期喉癌的临床资料进行回顾性分析，其中行扩大喉部分切除术４８例（单纯手术２５例，手术加放疗１９例）；喉全切除术６４例（单纯手术３９例，手术加疗疗法２５例）。结果：喉部分切除术组和喉全切除术组３年和５年生存率分别为７７．１％、６６．７％和９７．７％、７１．１％；各组单纯手术和手术加放疗的３年和５年生存     

老龄喉癌患者手术治疗远期疗效分析

目的：探讨老龄喉癌患者手术疗效及预后因素。方法：≥65岁的喉癌患者110例中,行喉部分切除术62例,喉全切除环咽吻合术（Arslan术）8例,喉全切除术40例。53例联合放疗及化疗。结果：4例失访,5、10年生存率分别为66.6%和44.2%;5、10年无瘤生存率分别为57.0%和38.4%,中位生存期84个月。拔管率87.1%。单因素分析组织学分级、治疗模式、淋巴结转移、原发部位不同组间生存分布的差异具有统计学意义（P〈0.01）;肿瘤分期、手术方式、复发、性别不同组间生存分布的差异具有统计学意义（P〈0.05）。多因素分析组织学分级及治疗模式对本组患者生存率影响较大,分化程度低及综合治疗者生存期短。结论：喉功能保全性手术是治疗老龄喉癌患者的有效方法;综合治疗者预后差,不适用于切缘阴性者。     

Pearson术式治疗晚期喉癌28例报告

目的：探讨Pearson术式在治疗晚期喉癌中的作用。方法：采用Pearson术式治疗28例晚期喉癌，对其中的26例同期行颈清扫术或分区性颈清扫术。结果：术后随访3～5年，27例(96．4％)能发声，其中发声良好者11例，一般14例，差2例。无一例误咽。3年生存率为78．6％，5年生存率为68．4％。结论：Pearson术式治疗晚期喉癌，既能保留喉的大部分功能，又能根治病变，提高了一部分传统上需做喉全切除术患者的生活质量。     

保留喉功能的T3期声门上喉癌的手术治疗

目的：探讨T3期声门上喉癌喉功能保留手术的可行性、技术操作和临床疗效。方法：回顾性分析1994～2003年收治的T3期声门上癌70例，均行喉功能保留手术，其中喉声门上水平部分切除术42例，喉声门上水平垂直部分切除术19例，喉环状软骨上部分切除术8例，喉近全切除术1例。以胸骨舌骨肌肌筋膜瓣、颈阔肌肌皮瓣、双蒂接力肌甲状软骨膜瓣、甲状软骨膜瓣等修复喉腔组织缺损，重建喉功能。全部患者均接受术后放疗（剂量50～60Gy）。结果：3年生存率为79．2％，5年生存率为68．4％。70例患者中已拔管60例，拔管率为85．7％。全部患者均恢复经口进食，无明显呛咳及吞咽困难。所有患者均发声成功，无一例因喉腔闭锁而致发声失败。结论：T3期声门上癌虽属晚期喉癌，但只要严格掌握适应证，熟练运用多种修复方法，提高外科手术技巧，保留喉功能是可行的。     

Intraoperative management of the thyroid gland in laryngeal cancer surgery.

OBJECTIVE: To determine if it is necessary to perform a hemithyroidectomy routinely with all total laryngectomies or if it should be reserved for selected cases. DESIGN: A retrospective analysis of 215 cases who had been operated on due to laryngeal cancer in our clinic between 1985 and 1999. SETTING: In only 182 cases, hemithyroidectomy and isthmectomy were performed together with laryngeal surgery. Of these, 98% were male. Their ages ranged between 42 and 70 years. The tumour was located in the supraglottic region in 93 (51%) and in the glottic region in 24 (13%) cases. In 65 cases (36%), the tumour was transglottic. Twenty cases of transglottic tumours (31%) and 3 cases of glottic tumours (12.5%) were found to have subglottic extension. METHODS: Total laryngectomy with unilateral or bilateral neck dissection and hemithyroidectomy on the tumour side plus isthmectomy were performed on all patients. On the pathologic specimens, subglottic extension was measured anteriorly and posteriorly from the free edges of the vocal cords. The specimens were stained with hematoxylin and eosin and examined under a light microscope. MAIN OUTCOME MEASURES: With glottic and transglottic carcinomas, the need for thyroidectomy may be based on the intraoperative assessment of the thyroid gland. In subglottic carcinomas, a hemithyroidectomy should routinely be performed. There may be no need to perform thyroidectomy in all total laryngectomy cases. RESULTS: The thyroid gland was invaded by squamous cell carcinoma in only 2 cases (1%). Both of these cases were transglottic tumours staged as T3 and T4 and had a subglottic extension more than 1 cm. CONCLUSIONS: We recommend routine hemithyroidectomy and isthmectomy during total laryngectomy only in cases with subglottic extensions more than 1 cm or thyroid cartilage invasion with tumour. In the other cases, assessment of extralaryngeal invasion and thyroid gland invasion by the tumour will determine whether thyroidectomy should be performed.     

205例喉癌的手术方式与远期疗效分析

目的分析1990年以来喉癌手术治疗的方法及其远期疗效，以改进治疗并提高生存率。方法对1990年1月-2004年10月间手术治疗的205例病例进行临床随访、病历资料分析。其中声门上型52例，声门型149例，声门下型4例；按UICC 1997年分期标准Ⅰ期48例，Ⅱ期88例，Ⅲ期44例，Ⅳ期25例。行支撑喉镜下声带切除术1例，撕皮术2例，喉裂开声带切除术9例，未行气管切开的喉垂直部分切除术16例，喉垂直部分切除术25例，水平半喉切除术7例，Arslan（咽气管吻合）手术15例，环舌骨会套固定术（criicohyoidoepidottopexy，CHEP）57例，喉次全切除术16例，喉全切除术57例。结果205例仅4例失访，Kaplan—Meier法统计总的1年生存率96．0％，3年生存率84．8％，5年生存率为79．4％，其中声门上型1年生存率88．3％，3年为67．5％，5年为65．0％；声门型1年生存率99．3％，3年为91．3％，5年为84．7％，喉功能保存率72．7％。早期肿瘤（Ⅰ、Ⅱ期）与晚期肿瘤（Ⅲ、Ⅳ期）患者之间生存率差异有统计学意义（P〈0．01），肿瘤不同发病部位（声门型、声门上型）患者之间生存率差异有统计学意义（P〈0．05）。结论喉癌手术治疗效果好，喉功能保存率高，其预后与肿瘤分期、发病部位有关。提倡严格掌握手术指征，在保证手术安全边缘的情况下，制定个体化治疗方案，运用最优的手术切除和功能重建方法，综合治疗，提高生存质量。     

The incidence of thyroid gland invasion in advanced laryngeal squamous cell carcinoma

IntroductionInvasion of the thyroid gland is not a general feature of advanced laryngeal carcinoma. There is no need for performing thyroidectomy in all total laryngectomy cases.ObjectivesTo evaluate the frequency of the thyroid gland invasion in patients with advanced laryngeal squamous cell carcinoma submitted to total laryngectomy and thyroidectomy and to determine whether clinical and pathological characteristics of laryngeal carcinoma can predict glandular involvement.MethodsA retrospective case series with chart review, from March 2009 to January 2018, was undertaken in the the Princess Norah Oncology Center, King Abdul-Aziz Medical City, Jeddah/KSA. An inception cohort of 56 patients with laryngeal squamous cell carcinoma was considered. Nine cases were excluded. All patients had advanced stage cancer of the larynx (clinically T3‒T4) and underwent total laryngectomy in association with thyroidectomy. Total thyroidectomy was performed in all bilateral lesions or if there was suspicion of contralateral lobe involvement. Hemithyroidectomy was performed in all lateralized lesions. Retrospective histopathologic analysis of thyroid specimens was subsequently performed. The frequency of thyroid gland invasion was calculated and analysis of demographic, clinical and pathological characteristics associated with thyroid gland invasion was performed.ResultsIn all, 47 patients underwent total laryngectomy (40 treated with primary laryngectomy and seven treated with salvage laryngectomy following radiation failure or chemoradiation failure). Hemithyroidectomy was performed in 42 patients and the total thyroidectomy was performed in five patients. The overall frequency of invasion of the thyroid gland was 4.3%. Glandular involvement was seen in one advanced transglottic squamous cell carcinoma and one subglottic. In spite of thyroid cartilage invasion in 25.5% of cases detected in the preoperative radiological imaging, only one case demonstrated microscopic thyroid gland invasion.ConclusionsThyroidectomy may only be required during total laryngectomy for selected cases of advanced transglottic tumors and tumors with subglottic extension more than 10 mm.     

环上喉次全切除喉功能重建41例的疗效分析

目的 :探讨环上喉次全切除喉重建术的治疗效果和喉功能重建效果。方法 :回顾性分析 4 1例接受该术式的T2 ～T4期喉鳞癌患者的临床资料。其中声门型 35例 ,声门上型 6例 ;行环舌会厌固定术 2 3例 ,环舌固定术 18例。结果 :3年生存率 83.3% (30 / 36 ) ,5年生存率 71.4 % (2 0 / 2 8) ;拔管率为 92 .7% (38/ 4 1)。 1例因误吸严重而行咽气管分离术 ,余 4 0例均恢复了正常吞咽。全部患者均能利用新喉发音。结论 :环上喉次全切除喉功能重建术既能彻底切除肿瘤 ,又能恢复喉的三大基本功能 ,是中、晚期喉癌治疗的有效方法之一。     

Near-total laryngectomy in advanced cancers of the larynx and pyriform sinus: a comparative study of morbidity and functional and oncological outcomes.

This prospective study, performed from 1991 to 1996, analyzes the differences in oncological safety, functional utility, and surgical morbidity in 14 advanced lesions of the larynx (10 T3 and 4 T4; 7 N+) and 40 pyriform sinus lesions (1 T2, 20T3, and 19 T4; 29 N+) subjected to Pearson near-total laryngectomy. The laryngeal cancer patients healed much faster, with a minimal wound complication rate of 28%, in comparison to the 68% rate encountered in the pyriform sinus cases (p < .05). The 3-year disease-free survival rate for the laryngeal cancers was 74%, while the 5-year survival rates for pyriform sinus cases were 66% for medial wall lesions and 54% for lateral wall lesions. Lung-powered shunt speech deemed qualitatively superior by acoustic analysis was obtained in 81% of the individuals (93% in laryngeal cases and 76% in pyriform sinus cases). Aspiration-free deglutition was achieved by 90% over periods ranging from 15 to 30 days. This study conclusively attests to the therapeutic efficacy of near-total laryngectomy for advanced lesions of the larynx and pyriform sinus that are unsuitable for radiotherapy, that are deemed too large or risky (because of aspiration) for partial laryngectomy, and that in the past would have merited total laryngectomy.     

T2 laryngeal carcinoma with impaired mobility: subtypes with therapeutic implications

The aim of this study was to evaluate the outcome in the treatment of T2 laryngeal carcinoma with impaired laryngeal mobility, comparing surgical management to radiotherapy in terms of local control and survival. The files of 66 patients treated between 1988 and 1994 were retrospectively studied for tumor location, treatment and outcome. Forty-two patients were treated surgically and 24 by radiotherapy. Follow-up averaged 8.5 years. Local recurrence occurred in 12.5% of the cases treated by conservation laryngeal surgery and in 21% of the cases by radiotherapy. Ultimate laryngeal preservation was achieved in 90.9% of the cases initially treated by partial laryngectomy and in 87.5% of the cases treated by radiotherapy. Five-year actuarial survival rates were 90% and 28%, respectively. A higher rate of metastases and second primaries occurred in the group treated by radiotherapy. T2 laryngeal carcinoma amenable to partial laryngectomy had a higher local control rate than the cases not amenable to conservation surgery and treated by radiotherapy. Tumors differed in the two treatment groups in location and extensions, despite the fact that all were T2 tumors. We emphasize the limits of retrospective studies. Only prospective randomized studies will determine the true results of surgery versus radiotherapy for a homogeneous subset of T2 laryngeal tumors. Received: 17 May 2001 / Accepted: 21 August 2001