全喉切除术后气管造口复发癌

目的探讨喉癌、下咽癌全喉切除术后气管造口复发癌病因、诊断及治疗,提出气管造口复发癌预防措施。方法回顾性分析16例喉癌、下咽癌全喉切除术后气管造口复发癌临床资料,对比手术和非手术治疗的效果。结果16例气管造口复发癌全喉切除术前均有肿瘤声门下侵犯,5例术后切缘阳性;手术治疗11例,5例术后病理证实为淋巴结转移;术后生存5～68个月,4例（4/9）存活3年以上;放射治疗或未治疗5例,生存3～7个月;手术明显延长生命（P<0.01）。结论气管造口复发癌病因可能与肿瘤残存、种植、淋巴结转移、肿瘤分化有关;预后差,应重在预防。全喉手术肿瘤的彻底切除,标本切缘的显微监控,精细的颈淋巴清扫手术是降低本病发生率的重要保证。     

喉癌、下咽癌复发的临床分析和治疗转归

目的探讨喉癌、下咽癌术后复发的原因及挽救性手术的可行性.方法回顾分析98例复发性喉癌、下咽癌的临床资料.68例行癌复发手术切除及术后常规放疗,其中喉部分切除术后局部复发21例,颈淋巴结转移7例,局部复发并颈淋巴结转移5例;全喉切除术后气管造瘘口复发癌8例;下咽癌切除术后局部复发2例,颈淋巴结转移15例;30例行单纯放疗或姑息性治疗.68例行癌切除术和(或)改良根治性颈清扫术,其中胸大肌皮瓣修补术29例,胃上提代食管下咽15例,游离结肠上徙代下咽食管2例.结果喉癌手术后1年、3年生存率分别为96.10%和33.33%,下咽癌手术后1年、3年生存率分别为64.71%和5.88%,而单纯放疗或姑息治疗1年及3年的生存率仅为10%和0%.结论复发性喉癌、下咽癌的预后较差,适当的手术治疗可延长患者生命,提高生存质量.     

保留部分环状软骨环的喉全切除术

目的研究喉癌及下咽癌手术中保留部分环状软骨环对患者的影响。方法回顾性分析32例中晚期喉癌、下咽癌患者,术中采取于环状软骨弓中部水平裂开,只保留部分环状软骨环的喉全切除术,保留的部分环状软骨环与气管一起与颈前造瘘,术后患者不佩戴全喉套管,观察患者咳嗽反射、气道分泌物、造瘘口变化及出院后有无造瘘口狭窄及造瘘口复发情况。结果 32例患者术后均咳嗽反应及气道分泌物明显减少,造瘘口周围红肿较轻。术后随访12~60个月,造瘘口无明显狭窄,无造瘘口肿瘤复发。结论中晚期喉癌及下咽癌患者保留部分环状软骨环的喉全切除术,可避免术后佩戴全喉套管,减少刺激性咳嗽,减轻局部炎症反应,更有利于气道分泌物的排出,缩短患者术后恢复时间,预防气管造瘘口狭窄。     

喉癌术后复发及颈部转移临床治疗的远期疗效观察

目的：探讨治疗喉癌术后复发及颈部转移的有效方法。方法：回顾性分析我院1990年4月～1998年4月收治的喉癌术后复发及颈部转移患者70例，其中局部复发癌3i例，气管造口复发癌15例，颈淋巴结转移24例。结果：31例局部复发癌中，19例二次手术者术后15例生存，4例死亡；未行手术治疗的12例分别在1～3年内死亡。15例气管造口复发癌中，9例二次手术者术后5例生存，4例死亡；未行手术治疗的6例均在18个月内死亡。24例颈淋巴结转移者中，15例二次手术者术后8例生存，7例死亡；9例未行Ⅱ期手术者2年内死亡。结论：喉癌术后定期复查及系统的临床随访，有利于喉癌术后复发及颈部转移的早期发现和早期治疗；二次手术是喉癌术后复发及颈部转移临床治疗的重要措施；放射治疗或化学治疗作为综合治疗手段有一定疗效，但其疗效有限。     

喉切除后气管造瘘口复发癌

喉切除术后气管造瘘口复发癌的发生是影响喉癌、下咽癌及颈段食管癌患自下而上的重要因素。为提高临床医师对该病的认识和正确合理地制定喉癌、下咽癌及颈段食管癌的治疗方案，本综述喉切除后气管造瘘口复发的病因、发病机理、间隔时间、治疗、预后及预防。     

全喉切除术后短期发生气管造口复发癌1例及文献复习

正气管造口复发癌多发生在全喉切除术后4~30个月内[1],其发生率约为3%~40%[2],是喉癌、下咽癌的术后严重并发症;该病治疗难,预后差,死亡率高。因此进一步认识气管造口复发癌的病因、预防以及治疗具有重要的意义。该类病例基层医院遇见较少,为了最大限度减少喉癌、下咽癌的术后气管     

喉癌病人喉部分切除术的远期疗效分析

目的：通过对不同类型喉切除术的临床资料进行分析，对喉部分切除术与喉全切除术的远期疗效加以比较。方法：总结了我们近年治疗的手术治疗喉癌患者中的195例，根据原发肿瘤的部位和侵及范围，对上述195例患者采取不同方法共施行喉裂开肿瘤切除术14例；声门上水平喉切除78例，其中包括声门上扩大水平喉切除术24例，垂直部分喉切除24例，其中包括额侧喉部分切除4例；喉次全切除31例，包括水平垂直喉切除28例，环状软骨舌骨会厌固定术3例，喉全切除术48例。上述病例均经3－5年随访。结果：喉全切除术患者术后5年整体生存为79．2％，部分喉切除者5年整体生存为83．7％，两组间比较无明显差异。术后癌转移和复发是主要的致死原因。颈淋巴结转移对声门上型喉癌的5年生存率有明显影响。通过施行喉部分切除术，所有患者的喉呼吸及发声功能都得到了不同程度的保留。结论：对喉部分切除术的分类及术式选择实行标准化，在彻底切除肿瘤的同时尽可能保全喉功能，对提高喉癌手术的治疗效果和患者的生存质量均具有重要意义。     

喉癌和下咽癌颈淋巴结转移临床对比分析

目的：探讨喉癌、下咽癌患者颈淋巴结转移的特点和分布规律。方法：对全喉切除术同期及复发后第1次行颈淋巴结清扫的129例喉癌、下咽癌患者的临床资料进行回顾性对比分析，研究不同类型的喉癌、下咽癌患者颈淋巴结的转移情况。结果：声门上型喉癌、下咽癌患者易发生早期淋巴结转移；下咽癌患者的转移淋巴结融合率高，颈静脉下区出现阳性淋巴结的比率高；声门上型喉癌、下咽癌患者原发病灶分化差的比率相对偏高；同期与复发后行颈淋巴结清扫的患者原发病灶分期差异无显著性意义。结论：对T2期及以上的声门上型喉癌及下咽癌患者，尤其当细胞分化比较差时，即使颈淋巴结阳性体征不明显亦应积极考虑颈淋巴结清扫问题，对下咽癌患者行颈淋巴结清扫时应考虑彻底清扫颈静脉下区的淋巴结。     

气管造口复发癌的手术治疗

目的：探讨气管造口复发癌的治疗方法。方法：气管造口复发癌患者共31例，对怀疑有颈淋巴结转移的12例行改良根治性颈清扫术。Ⅰ、Ⅱ型气管造口复发癌共25例，均彻底切除肿瘤；Ⅲ、Ⅳ型共6例，3例彻底切除肿瘤。31例均采用胸大肌肌皮瓣修复颈部组织缺损。结果：Ⅰ型13例中，随访满3年者7例，死亡4例。Ⅱ型12例中，随访满3年者8例，死亡5例。Ⅲ、Ⅳ型多在3年内死亡。31例中，咽瘘发生率为12．9％，气胸发生率为9．7％。结论：气管造口复发癌预后较差，对适合的病例行适当的手术治疗可延长患者生命，提高生存质量。     

喉全切除术在治疗中晚期喉癌中的应用

目的:探讨喉全切除术治疗中、晚期喉癌的疗效。方法:对573例喉癌患者行喉全切除术,声门上型370例,声门型90例,跨声门型75例,声门下型21例,放疗后复发17例。其中143例行单纯喉全切除术,430例同期行颈廓清术(单侧239例,双侧191例)。在喉全切除术中行气管外口造大孔术,共308例。结果:3、5及10年生存率分别为69.5%(398/573),61.1%(350/573),46.3%(149/322);220例死亡病例中,45.0%(99/220)死于局部复发;22.3%(49/220)死于颈部转移。术腔感染和咽瘘的发生率分别为12.2%,5.2%。16.6%气管外口造大孔术患者气管外口再度狭窄需行Ⅱ期气管外口扩大术或戴套管维持呼吸。13.6%的患者可以行喉部分切除术,由于不同的原因行喉全切除术。结论:喉全切除术作为治疗中、晚期喉癌的主要手段,其适应证随喉癌外科技术的发展而逐渐缩小。在采取积极的颈廓清术情况下,局部复发是主要的死亡原因。     

气管造口复发癌的处理

OBJECTIVE: To study effective prevention and treatment of stoma recurrence after laryngectomy. METHODS: A retrospective review of 23 patients with stomal recurrence after laryngectomy was conducted. Among all 23 cases, 20 cases were referred to Cancer Hospital of Chinese Academy of Medical Science from other hospitals. The etiopathology of stomal recurrence after laryngectomy, feasibilities of various kinds of operative treatment and outcomes of clinical management in this series were analyzed. RESULTS: The subglottic extension and invasion of paraglottic portion of laryngeal cancer and peritreacheal metastasis may result in stomal recurrence. The survival period of 18 cases surgically treated was longer than that of 5 cases untreated or irradiated and/or chemotherapied. The 1- and 5-year survival rates were 40.7% and 20.4%, respectively. The common complication was pharyngeal fistula. Surgical treatment may relieve local pain, improve breathing, resume swallowing and decrease cancer ulcer bleeding. CONCLUSIONS: The overall prognosis of peristomal recurrence after laryngectomy was awful and dismal. Prevention should be stressed in surgical treatment of the subglottic extension, invasion of paraglottic portion and peritreacheal node metastasis. A proper surgical treatment in some cases of stomal recurrence would prolong the lifetime and advance the life quality of the patients.     

气管造口复发癌的处理

目的探讨气管造口复发癌的治疗方法.方法对中国医学科学院肿瘤医院1994年6月～2001年8月诊治的23例气管造口复发癌的临床资料进行了回顾性的分析.外院转来病例20例,本院3例.分析复发的原因,探讨不同手术的可行性,对比手术和非手术治疗的效果. 结果 23例气管造口复发癌中,未行手术病例5例,均在1～6个月死亡,平均存活5.7个月.接受手术18例中,随诊6个月～7年2个月,生存超过6个月的16例,1年生存率40.7%,3年生存率20.4%.术后咽瘘6例,其中1例伴有颈总动脉大出血,抢救成功;1例伴有皮瓣局部坏死,术后1周颈总动脉破裂大出血死亡;1例偏瘫昏迷后抢救成功,并同时皮瓣局部坏死.秩和检验,手术患者的生存时间与未手术者差异有显著性(t=17,P<0.05).结论气管造口复发癌预后极差,应注意预防.气管造口复发癌与声门下侵犯、喉前气管食管沟淋巴结转移、局部肿瘤残存和种植有关.对适合的病例行适当的手术治疗,可延长患者生命,减少痛苦,提高生存质量.     

气管造口复发癌的临床分析和治疗转归

目的探讨气管造口复发癌的原因及手术治疗的可行性。方法回顾分析13例气管造口复发癌的临床资料,分析复发原因,对比手术和非手术治疗的效果。结果13例气管造口复发癌中,未行手术治疗4例,除1例存活1年3个月,其余3例均在2～7个月死亡;接受手术治疗9例,6例存活1年以上,4例随访3年,有1例仍存活。手术组1年生存率显著高于非手术组。结论气管造口复发癌预后较差,适当的手术治疗可延长患者生命,提高生活质量。     

Stomal recurrence--etiologic factors and prevention

Out of a total of 340 laryngectomies performed in the Department of Otorhinolaryngology at Kobe University Hospital from 1969 to 1982, there were 20 stomal recurrences. In the preoperative tracheostomy group, 6 out of 52 patients (11.5%) developed stomal recurrence compared to 14 out of 288 (4.9%) in the operative tracheostomy group. Of these 20 stomal recurrences, 7 were supraglottic with 1 subglottic extension, 9 were glottic with 8 subglottic extensions, and 4 were primary subglottic cancers. The mean interval between the laryngectomy and stomal recurrence was 16 months and ranged from 20 days to 55 months after laryngectomy. We analyzed our series together with recent material which had been subjected to pretracheal and paratracheal lymphatic dissection. Reports from the literature were also used. Tumor cell inoculation in the tracheostomy wound and persistent pretracheal and paratracheal lymph node lesion are the two most likely major etiologic factors. The above evaluation leads us to propose the following preventive measures: 1) thorough irrigation of the wound following the removal of the larynx, 2) complete excision of the tracheostomy tract for preoperatively tracheostomized patients, 3) pretracheal and paratracheal lymphatic dissection for subglottic lesion, 4) in the above cases, laryngectomy should be followed by peristomal radiotherapy.     

Comparison of two face masks used to deliver early ventilation to laryngectomized patients

Emergency airway management of laryngectomized patients is inherently complicated by the altered contours of their necks, by the presence of awkwardly placed tracheostomas, and by stomal strictures. Effective ventilation can also be compromised by the presence of hypertrophic peristomal scar tissue and by tumor recurrence. One common method of airway management involves the use of a pediatric face mask attached to a standard ventilation bag. We conducted a study of 20 laryngectomized patients to determine if they could be adequately ventilated through two commonly used pediatric face masks--the Laerdal mask and the Ambu mask. Ten of these patients had had an end tracheostoma in place for at least 1 year, and the remaining 10 had undergone stoma placement only recently. We found that all 20 patients achieved an adequate peristomal seal when using the Laerdal mask, whereas only 11 adequate seals were achieved with the Ambu mask. Therefore, we recommend that the Laerdal pediatric mask be used for early ventilation in laryngectomized patients.     

Stomal recurrence following total laryngectomy--a clinicopathological study

A clinicopathological study of 10 cases of stomal recurrence following total laryngectomy treated at Kurume University Hospital from 1971 to 1986 was completed. The results of this study are summarized as follows: 1) The frequency of stomal recurrence was 5.8%. 2) Of these 10 cases, 3 cases were supraglottic (3%), 5 cases were glottic (7%), and 2 cases were subglottic (29%) carcinomas. The incidence of stomal recurrence was higher in subglottic carcinomas. 3) Nine cases out of 10 extend to the subglottic region. 4) The incidence of stomal recurrence was higher in emergency tracheostomy case. 5) Average of period from total laryngectomy to stomal recurrence was 9.7 months. 6) It is suggested that the cause of stomal recurrence is metastasis to the paratracheal lymphnode. 7) In order to prevent stomal recurrence, it is important to dissect paratracheal soft tissues bilaterally in high risk cases. 8) With regard to treatment, it is better to remove surgically the tumor and paratracheal soft tissues as completely as possible and to do postoperative radiation.     

Post-laryngectomy stomal recurrence: tumour implantation or paratracheal lymphatic metastasis?

In the treatment of obstructing laryngeal cancer, an association has often been noted between emergency tracheotomy for airway relief and subsequent post-laryngectomy stomal recurrence. It is however unclear whether this is due to tumour implantation in the tracheotomy track, or paratracheal lymph node metastasis. To investigate the pathophysiology of stomal recurrence, the recurrence rate and clinical outcome of 26 cases of T3N0M0 glottic cancer treated with emergency tracheotomy and subsequent laryngectomy were analysed, and compared with 65 stage-matched cases treated with laryngectomy alone. Analysis shows the 'emergency tracheotomy' group to have a very poor prognosis with a higher incidence of recurrence at the stoma, and also in the regional lymph nodes. These findings suggest that paratracheal lymph node metastasis is an important mechanism in the development of stomal recurrence and thus has considerable implications for the prevention of such a recurrence following laryngectomy in the patient presenting with malignant airway obstruction.     

Emergency laryngectomy

Emergency laryngectomy is a laryngectomy carried out for malignant obstruction of the upper airway within 24 h of admission. This combines relief of the obstruction with definitive primary cancer surgery, and is thought to reduce the risk of post-laryngectomy stomal recurrence. During a 5-year period, 13 patients with upper airway obstruction from squamous cell carcinoma were treated in two departments by emergency laryngectomy. Total laryngectomy was carried out after the diagnosis of squamous cell carcinoma of the larynx (n = 11), or piriform fossa (n = 2), had been confirmed by laryngoscopy and frozen section biopsy. The actuarial 5-year survival was 47%, and no patient in this series developed stomal recurrence. The management of the airway obstruction, and the post-laryngectomy complications, did not differ from those encountered with more conventional treatment. Our experience with this approach suggests that emergency laryngectomy is a satisfactory method of managing airway obstruction due to squamous cell carcinoma of the larynx.