环状软骨上喉次全切除术后喉功能的临床分析

目的分析喉鳞状细胞癌患者接受环状软骨上喉次全切除(supracricoid partial laryngectomy,SCPL)术后喉功能的情况。方法回顾性分析2000~2006年采用SCPL治疗喉鳞状细胞癌患者38例,其中声门上型17例,声门型21例;术后辅助放射治疗8例,剂量累计为60~65 Gy。对切除(或)保留会厌、保留一侧(或)双侧杓状软骨患者术后呼吸、发音、吞咽功能分别进行评估。所得结果运用统计学方法进行检验。结果所有患者随访至今,无失访;3年生存率81.6%,5年生存率73.7%。其中声门上型喉癌3年生存率76.5%,5年生存率64.7%;声门型喉癌3年生存率85.7%,5年生存率81.0%。所有患者均拔除气管套管,拔管率为100%。切除会厌和一侧杓状软骨患者的误咽评分、平均气管套管拔除时间、平均鼻饲胃管拔除时间和平均住院天数均高于其他组,差异具有统计学意义;而呼吸、发音评估各组之间比较差异无统计学意义。结论 SCPL对喉癌治疗和喉功能保留有积极意义,临床分析表明会厌和一侧杓状软骨切除对于患者远期喉功能恢复无影响。

Clinical analysis of laryngeal function after supracricoid partial laryngectomy

Objective To analyze the laryngeal function after supracricoid partial laryngectomy （SCPL） in patients suffering from laryngeal squamous carcinoma. Methods Clinical data of 38 patients suffering from laryngeal squamous carcinoma and underwent SCPL from the year 2000 to 2006 was analyzed retrospectively. Of them, the tumor was supraglottic in 17 cases and glottic in 21. Postoperative radiotherapy with 60 -65 Gy of cumulative radiation dose was applied to 8 patients. Their functions of respiration, phonation and deglutition were evaluated and analyzed statistically. Results The 3-year and 5-year survival rates of all patients were 81.6% and 73.7% respectively. The 3-year and 5-year survival rates of supraglottic group were 76.5% and 64.7% , while those of glottic group were 85. 7 % and 81%. Decannulation was achieved in all cases. The average decannulation time, mean nasogastric tube removing time and duration of hospital stays in patients with removal of epiglottis and unilateral arytaenoid cartilage were longer than those of the others, and the differences were statistically significant. However, evaluation of their respiration and phonation showed insignificant differences. Conclusions Supracricoid partial laryngectomy is positive for resetvation of laryngeal function in the treatment of laryngeal carcinoma. Removal of epiglottis and unilateral arytenoid will not influence the long-term recovery of laryngeal function.