喉癌患者生活质量分析

介绍喉癌患者生活质量研究的概况,强调开展相关研究。喉癌病人生活质量分析的重要性,比较分析工具——多种量表,推荐研究策略——生存率分析与生活质量相结合、描述性研究与分析性研究相结合的方法,并评述了国内外     

阻塞性睡眠呼吸暂停低通气综合征手术疗效

阻塞性睡眠呼吸暂停低通气综合征是全身系统的疾病,严重影响患者的生活质量和寿命。本文就目前的手术方法治疗及其对生活质量的影响做一综述。     

喉癌患者生存质量的研究

喉癌是耳鼻咽喉科常见的恶性肿瘤,严重危害人类健康,现仍以手术治疗为主。喉癌手术可严重影响患者的生存质量,包括呼吸、发音、吞咽等生理功能,同时也导致了许多社会心理问题,本文就喉癌患者的生存质量作一综述。     

变应性鼻炎患者生活质量研究

变应性鼻炎(allergic rhinitis,AR)属非致死性疾病,容易被轻视,但其鼻部、眼部等相关受累器官的症状会显著影响患者的生活质量.AR患者生活质量受影响的方面及程度,以及如何全面准确的研究AR患者生活质量目前尚无定论,本文就其近年的研究进展做一综述.     

术中切缘冰冻分析作为预后因素在早期声带癌激光声带切除术中的应用

目的早期声带癌经内镜切除术后,手术切缘的状况对患者预后的影响存在着争议。即使对切缘阳性的患者再次行喉镜检查,也很难见到肿瘤残留。术中行冰冻切片分析,已成为常规再次检查的一种手段。本研究的目的是评估根据术中切缘冰冻结果决定手术切除范围的患者预后影响因素。方法回顾性分析收录有连续随访记录的早期声带癌经内镜CO2激光切除的患者,评估手术时切缘的情况、疾病的复发率以及生存资料。计算出Kaplan—Meir生存率并通过对数秩检验和卡方检验来进行比较。结果纳入2004年2月-2011年9月间75例连续随访的患者。5年生存率和疾病特异性生存率分别为84％和98％。尽管扩大声带切除以获得切缘阴性,12个月内复发（P=0．019）和首次冰冻切缘阳性（P=O．001）的病例,提示较差的生存率。结论早期声带癌C（2激光切除,首次手术术中切缘的冰冻切片阳性结果和早期的局部复发,是整个生存率的不良标志。     

Transoral laser microsurgery for recurrence after primary radiotherapy of early glottic cancer

Objective

To analyze oncological results of transoral laser microsurgery (TLM) on recurrent early glottic cancer after primary radiotherapy.

Methods

The records of 53 patients treated by TLM for early (rTis–rT2) and advanced (rT3, rT4) recurrence after curative radiotherapy were retrospectively analyzed. Data on loco-regional control, overall survival, and disease specific survival were calculated by the Kaplan–Meier method. The larynx preservation rates were given absolutely.

Results

Mean post-therapeutic follow-up time after TLM for patients alive was 87.9 months. Twenty-two patients (42%) were cured by the first TLM procedure, but one of them underwent total laryngectomy after TLM due to chondronecrosis without evidence of residual tumor. Thirty-one patients (58%) developed another recurrence after TLM. Ten of them were cured by further laser procedures alone. Therefore, in 31 patients (58%), local recurrences were successfully treated by TLM alone. In 20 patients, recurrences could not be controlled by TLM: 14 patients underwent salvage laryngectomy and six palliative treatment. Three- and five-year loco-regional control rates for all patients were 46.1 and 38.8%. Three- and five-year overall survival rates were 67.5 and 53.3%. The corresponding 3- and 5-year disease specific survival rates were 68.6%, each. There was no statistically significant difference in loco-regional control or survival between patients presenting initially with early and advanced recurrence. Further recurrence after the first TLM procedure was associated with a statistically significant decrease in 3- and 5-year overall (56.6% vs. 81.8% and 40.2% vs. 70.5%; p = 0.03) and disease specific (48.9% vs. 100%, each; p = 0.001) survival. Ultimate local control rate including repeated TLM and salvage laryngectomy was 77.4%.

Conclusions

Many patients with recurrent glottic carcinoma after primary radiotherapy can be cured by single or repeated TLM as an organ-preserving procedure. However, in case of failure after TLM for the first recurrence, salvage laryngectomy should be considered early as local control by further laser surgery is unfavorable.     

Transoral laser microsurgery is the recommended treatment for early glottic cancers

Medical terminology frequently mistakes the instrument for the surgical procedure: endoscopic excision of laryngeal cancers existed long before laser came into use. Lasing obeys the same rules as those of suspension laryngoscopy: if adequate laryngeal exposure is not attained, then the procedure is at risk of being incomplete and of providing few satisfactory results. Because a certain degree of literary anarchy exists in terms of definitions for the different cordectomy types, the Nomenclature Committee of the European Laryngological Society has proposed a classification. This categorization is a synthesis and a compromise between members of the Society who had developed and used, for several years, a personal classification. The proposed classification has two aims: to better understand each surgeon's technique in function of the tumoral extent; and to compare more rigorously the postoperative results. This classification includes the following procedures: Subepithelial cordectomy or decortication (Type I); Subligamentous cordectomy (Type II); Transmuscular cordectomy (Type III); Total or complete cordectomy (Type IV); Extended cordectomy encompassing the contralateral vocal fold (Type Va); encompassing the arytenoid (Type Vb); encompassing the ventricular fold (Type Vc); encompassing the subglottis (1 cm) (Type Vd).     

Transoral laser surgery for early glottic cancers

OBJECTIVE: To demonstrate the oncologic safety of transoral endoscopic laser surgery in early glottic cancers. PATIENTS: The study included 107 patients with early glottic cancers. The disease was in situ in 21 (19.6%) and infiltrative in 86 (80.4%), of which 52 (48.6%) were stage T1a, 17 (15.9%) were T1b, 13 (12.1%) were T2, and 4 (3.7%) were TX lesions. One hundred three patients (96.3%) were treated primarily, whereas 4 patients (3.7%) were operated on after radiotherapy failure. Anatomically, 77 lesions (72.0%) involved the anterior or middle third of the vocal cord; 14 lesions (13.1%) involved a single cord and the anterior commissure; 4 "horseshoe" lesions (3.7%) involved both cords and the anterior commissure; 7 lesions (6.5%) involved the posterior third of the cord reaching the vocal process of the arytenoid; and 5 cases (4.7%) involved both cords separately. RESULTS: There were 17 (15.9%) local recurrences (10 among patients with single cord lesions, 5 among patients with cord and anterior commissure lesions, and 2 among patients with lesions involving both cords), and 1 regional recurrence. One hundred one patients (94.4%) were alive and disease free at a median of 40.7 months. Three patients (2.8%) were alive with disease. One patient (0.9%) died of other causes. Two patients (1.9%) died of a second primary cancer. The overall larynx preservation rate was 92.5%. Recurrence-free survival was 86.6% at 2 years, 84.1% at 5 years, and 78.1% at 10 years. CONCLUSION: Transoral laser surgery is an oncologically safe, function-preserving modality for treatment of early glottic cancers.     

Transoral laser surgery for early glottic carcinoma

This prospective study evaluates the oncological results of transoral laser surgery (TLS) for glottic carcinoma categorized Tis, T1 and T2 in a large, unselected group of 285 consecutive patients from a university-based referral center that uses transoral laser surgery as the standard approach to these tumors. Patients were treated between 1 January 1987 and 31 December 1996. Thirty-three patients had Tis disease, 174 T1 tumors and 113 T2. Main outcome measures were local control with initial therapy, ultimate local control, regional control, organ preservation, overall survival and cause-specific survival. The 5-year uncorrected actuarial survival for all 285 patients was 71.1%, and cause-specific actuarial survival was 98.7%. Local control with initial treatment was 85.9%, ultimate local control with salvage for local treatment failures 98.5%, and regional control 98.4%. In all, 94.3% had their larynges preserved after 5 years. Although favorable oncological results for early laryngeal carcinoma treated with laser surgery are supported this study, no definitive recommendations can be given for the best single treatment. Partial laryngectomies lead to the highest local control rates reported so far, radiotherapy is believed to preserve voice best and laser surgery is associated with time- and cost-effectiveness, low morbidity, fair local control rates and excellent re-treatment options in case of local failure. All specialists dealing with the treatment of early glottic carcinoma should be able to offer these different treatment modalities to their patients and to deal specifically with each patient’s individual needs and preferences. Received: 29 October 1998 / Accepted: 2 July 1999     

Transoral laser microsurgery for advanced laryngeal cancer

OBJECTIVE: To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the treatment of advanced laryngeal cancer. DESIGN: Prospective case series study. SETTING: Multi-institution (academic, tertiary referral centers). PATIENTS: A total of 117 patients with pathologically confirmed T2 to T4 lesions, stage III or stage IV, glottic or supraglottic carcinoma of the larynx were treated with TLM from 1997 to 2004. All patients had a minimum follow-up period of 2 years. INTERVENTIONS: Transoral laser microsurgery in 117 patients, neck dissection in 91 patients, and adjuvant radiotherapy in 45 patients. MAIN OUTCOME MEASURES: End points analyzed included laryngeal preservation, overall survival, disease-free survival, local control, locoregional control, and distant metastases. Postoperative complications, tracheotomy rate, and feeding-tube dependence were also examined. RESULTS: The median follow-up period among surviving patients was 5 years. At 2 years, the percentage of patients with an intact larynx after treatment was 92%. The 2-year local control and locoregional control rates were 82% and 77%, respectively. The 2-year disease-free and overall survival rates were 68% and 75%, respectively. The 5-year Kaplan-Meier estimates were local control, 74%; locoregional, control, 68%; disease-free survival, 58%; overall survival, 55%; and distant metastases, 14%. Four patients (3%) experienced treatment-related deaths. Seven patients (6%) experienced a postoperative hemorrhage. Of those patients with organ preservation and no disease recurrence, 2 patients (3%) were tracheotomy dependent, and 4 patients (7%) were feeding-tube dependent. CONCLUSIONS: In patients with advanced laryngeal cancer, TLM with or without radiotherapy is a valid treatment strategy for organ preservation. Furthermore, low morbidity and mortality and excellent oncologic and functional outcomes make TLM an attractive therapeutic option.     

CO2激光微创手术治疗早期喉癌

目的观察CO2激光微创手术治疗早期喉癌的安全性、远期疗效。方法回顾性分析1999年10月至2007年5月接受CO2激光显微外科手术治疗91例声门型喉癌（Tis9例，pTla 45例，pTlb 25例，和PT2 12例），对其中20例患者术后创面前、后、中上、中下及深部切缘组织同时进行常规病理切片镜检及PCNA免疫组织化学测定。结果依照Kaplan—Meier方法计算5年整体生存率为92．72％，无瘤生存率84．62％。采用3mm安全界100个切缘标本中，发现癌细胞残留3个（2名患者）。结论早期喉癌CO2激光微创手术，不仅损伤小，愈合快，而且远期疗效好，采用3mm安全界可获得安全切缘。