喉癌46例临床手术疗效观察

目的探讨喉癌外科手术治疗的临床效果.方法回顾性分析2004年8月至2006年1月外科手术治疗的喉癌病例46例.按UICC2002年制定的分级标准,声门型40例,其中T1aN0M011例,T1bN0M09例,T2N0M06例,T3N0M01例,T3N1M02例,T4N0M03例,T4N1M08例.声门上型6例,其中T2N0M04例,T3N2M02例.手术方式：单纯声带切除术11例,环状软骨舌骨会厌固定术（CHEP）10例,环状软骨舌骨固定术（CHP）2例,垂直半喉切除术6例,声门上水平部分喉切除术4例,全喉切除术13例.20例病人同期行颈清扫术,其中改良性颈清扫术16例,分区性颈清扫术4例.PN＋病人术后3～4周开始颈部放射治疗,剂量60～70Gy.结果术后无咽瘘及误吸,拔管率100%,部分喉切除术病人喉功能恢复良好。1例垂直半喉切除术后1a复发行全喉切除.46例随访均满3a.2例术后造瘘口复发拒绝再手术死亡,2例死于肺转移.3a生存率分别为T1N0M0 100%（20/46）,95%CI（1.159～2.008）;T2N0M090%（9/10）,95%CI（0.919～1.414）;T3N0-1M080%（4/5）,T4N0-1M072.7%（8/11）95%CI（0.919～1.74）.结论早期喉癌行部分喉切除均可获得满意的生存率及喉功能保留,对于一侧或双侧杓状软骨未受侵的中晚期喉癌,环状软骨上部分喉切除术方法简单效果肯定.

Surgical Treatment for 46 Cases of Laryngo Carcinoma

Objective To observe the clinical effect of surgical treatment for laryngocarcinoma.Method We retrospectively analyzed august 2004 ～2006 years in January surgical treatment for 46 cases of laryngocarcinoma.UICC 2002 was enacted as the grading standards,40 cases of glottic,which T1aN0M0 11 cases,T1bN0M0 9 cases,T2N0M0 6 cases,T3N0M0 case,T3N1M0 cases,T4N0M0 3cases,T4N1M0 8 cases.Supraglottic six cases,which T2N0M0 cases,T3N2M0 2 cases.Surgical method：simple vocal cord resection in 11 cases,CHEP 10 cases,CHP2 cases,vertical semi-laryngectomy in 6 cases,supraglottic horizontal partial laryngectomy in 4 cases,total laryngectomy in 13 cases.Over the same period 20 patients neck dissection,modified neck dissection in which 16 cases,neck dissection surgery in 4 cases.PN＋patients after 3～4 weeks start neck radiation therapy,the dose 60～70 Gy.Results No postoperative pharyngeal fistula and aspiration were found,extubation rate was100%,partial laryngectomy patients with laryngeal function recovered well.1 cases of recurred a year after operation received the second laryngectomy.46 cases were followed up for at least 3 years.2 cases of recurrence after stoma surgery refused to receive the second operation died,2 patients died of lung metastasis.3-year survival rates wereT1N0M0 100%,T2N0M0 90%（9/10）,T3N0-1M080（4/5）,T4N0-1M0 72.7%（8/11）.Conclusion Early laryngeal cancer with partial laryngectomy can be obtained a satisfactory survival rate and laryngeal function preservation,for one or both arytenoid cartilage is not invasion in advanced laryngeal cancer,cricoid partial laryngectomy on the method is simple and has positive effects.