环状软骨上喉次全切除术及疗效分析

目的探讨环状软骨上喉次全切除术(简称环上喉次全切除术)的可行性及其疗效。方法回顾性分析1990—2001年43例行环上喉次全切除术的T1b～T4及术后放疗后复发的喉癌患者,声门上癌16例,声门癌21例,声门下癌2例;外院术后复发3例,放疗后复发1例。临床分级:T1b6例,T213例,T316例,T44例。应用3种不同的环上喉次全切除术进行治疗(17例行环上喉次全切除环舌骨固定术,24例行环上喉次全切除环舌骨会厌固定术,2例采用环上喉次全切除气管环舌骨会厌固定术)。16例患者辅以放疗。结果KaplanMeier法统计生存率,随诊中位时间57个月。全组总的3年累积生存率为90.7%,5年累积生存率83.7%。术后拔管率为95.3%(41/43)。保留双侧杓状软骨的拔管时间为14d,保留单侧杓状软骨的拔管时间为43d。术后8周评价误咽发生率为14.0%(6/43),切除会厌增加了术后的误咽及拔管时间(P<0.05)。结论环上喉次全切除术是一种在肿瘤根治和喉功能保全上能达到临床应用水平的术式。

Supracricoid partial laryngectomy for the treatment of laryngeal cancer

OBJECTIVE: To evaluate the oncological and functional outcomes in patients undergoing supracricoid partial laryngectomy (SCPL). METHODS: Forty-three cases underwent supracricoid partial laryngectomy with functional reconstruction in stage T1b-T4. In these cases, 16 were supraglottic cancers, 21 were glottic cancers, and 2 were subglottic cancers. Three types of supracricoid partial laryngectomy (cricohyoidopexy CHP, cricohyoidoepiglottopexy CHEP and tracheocricohyoidoepiglottopexy TCHEP) were employed accordingly. RESULTS: The 3- and 5-year accumulative survival rates were 90.7% and 83.7% respectively (Kaplan-Meier method). Median follow-up time was 57 months. Decannulation rate was 95.3% (41/43) in those. The mean time of decanulation was 14 days in patients preserved both cricoarytenoid units and 43 days in those only preserved one cricoarytenoid unit. The removal of epiglottis increased the risk of aspiration and prolonged time of decannulation (P < 0.05). CONCLUSIONS: Supracricoid partial laryngectomy for selected laryngeal cancer is feasible. The patients can gain satisfied survival rate and quality of life.