改良喉部分切除术治疗声门型喉癌的疗效分析

目的 探讨保留甲状软骨的喉部分切除术在治疗声门型喉癌中的可行性及其手术效果.方法 回顾性分析1999年1月至2009年1月收治的声门型喉癌患者128例,术中肉眼和病理证实甲状软骨内膜无癌细胞侵犯或甲状软骨局灶性破坏无需大范围切除的T2-3期病例,采用病例对照研究方法,按部位相同、TNM分期相同,年龄相差≤10岁,1∶1配对.研究组为保留甲状软骨的喉部分切除术患者,共64例,其中T2N038例,T2N16例,T2N21例,T3N0 17例,T3N12例;对照组为传统喉部分切除术患者,共64例,TNM分期同研究组.比较两组患者生存率、局部控制率和总拔管率.结果 研究组3年及5年累积生存率分别为89.8％,84.3％,对照组分别为91.5％,85.4％,两组比较差异无统计学意义（x2=1.687,P＞0.05）;研究组局部控制率为91.7％（55/60）,对照组为93.2％（55/59）,两组比较差异无统计学意义（x2=0.103,P＞ 0.05）;研究组总拔管率为98.3％（59/60）,对照组为89.8％（53/59）,两组比较差异有统计学意义（x2=4.933,P＜ 0.05）.结论 对于T2期和部分T3期声门型喉癌患者的治疗,与传统喉部分切除术式相比,保留甲状软骨的喉部分切除术在保证彻底切除肿瘤、保留足够安全缘的同时,保留了喉功能,其术后拔管率高,并发症发生率低,有助于改善喉癌患者术后的生活质量.

Efficacy of reserving thyroid partial laryngectomy for glottic laryngeal carcinoma

Objective To compare and evaluate the oncological and functional outcomes between reserving thyroid partial laryngectomy and traditional partial laryngectomy for the treatment of stage T2-3glottic laryngeal carcinoma.Methods One hundred and twenty-eight patients treated from January 1999 to January 2009 were selected from all glottic laryngeal carcinoma patients with stage T2-3,who underwent surgery combined with radiation therapy.A retrospective review was randomized and matched by tumour subsite,TNM stage and age,which were confirmed by pathology and observation without thyroid perichondrium invaded or only local invasion of thyroid cartilage,there was no need to extensively resect laryngeal cartilages.Patients were divided into reserving thyroid partial laryngectomy group（study group） and traditional partial laryngectomy group （control group）.Each group included 64 cases,which included T2N0 38 cases,T2N1 6 cases,T2N2 1 case,T3N0 17 cases,T3N1 2 cases.Local control rate,decannulation rate,the 3-year and 5-year accumulative survival rate were compared between two groups.Results The 3-year and 5-year accumulative survival rate were 89.8% and 84.3% in study group,91.5% and 85.4% in control group,there was no sognificant difference （x2 =1.687,P 〉 0.05）.The local control rate was 91.7 % （55/60） in study group and 93.2 %（55/59） in control group,there was no significant difference （x2 =0.103,P 〉0.05）.The decannulation rate was 98.3% （59/60） in study group and 89.8%（53/59） in control group,there was significant difference （x2 =4.933,P 〈0.05）.Conclusions Comparing with traditional partial laryngectomy,reserving thyroid partial laryngectomy is successful for treating properly selected stage T2-3 glottic laryngeal carcinoma.This operation has higher decannulation rate and lower complication,which is effective for reducing surgical invasion and facilitated the resumption of respiratory.