保留喉功能的T4声门癌的手术治疗

目的 探讨T4声门癌喉功能保留手术的方法和临床疗效。方法 对1982－1998年间22例T4声门癌患者进行手术治疗，切除肿瘤及受累的软骨和喉外组织，以胸骨舌骨肌筋膜瓣、颈阔肌皮瓣、颈阔肌筋膜瓣、甲状软骨膜瓣、下咽黏膜瓣等修复组织缺损，保留会厌或环状软骨板重建喉功能。全部患者均接受术后放射治疗（5000－6000cGy)。结果 全组病例3年生存率86．4％（19／22），5年生存率75．0％（15／20）。喉功能恢复（吞咽保护、呼吸、发音）为68．2％（15／22），喉功能部分恢复（吞咽保护、发音）31．8％（7／22）。结论 T4声门癌尽管可累及喉软骨和喉外组织，但经仔细选择的病例在彻底切除肿瘤的前提下保留喉功能是可行的。     

保留喉功能的T4声门癌的手术治疗

目的　探讨T4声门癌喉功能保留手术的方法和临床疗效。方法　对 1982～ 1998年间2 2例T4声门癌患者进行手术治疗 ,切除肿瘤及受累的软骨和喉外组织 ,以胸骨舌骨肌筋膜瓣、颈阔肌皮瓣、颈阔肌筋膜瓣、甲状软骨膜瓣、下咽黏膜瓣等修复组织缺损 ,保留会厌或环状软骨板重建喉功能。全部患者均接受术后放射治疗 (5 0 0 0～ 6 0 0 0cGy)。结果　全组病例 3年生存率 86 4 % (19/ 2 2 ) ,5年生存率 75 0 % (15 / 2 0 )。喉功能恢复 (吞咽保护、呼吸、发音 )为 6 8 2 % (15 / 2 2 ) ,喉功能部分恢复(吞咽保护、发音 ) 31 8% (7/ 2 2 )。结论　T4声门癌尽管可累及喉软骨和喉外组织 ,但经仔细选择的病例在彻底切除肿瘤的前提下保留喉功能是可行的     

晚期喉声门上型癌的手术治疗

目的探讨晚期喉声门上型癌手术治疗的方法及疗效。方法对64例晚期喉声门上型癌进行手术治疗,其中Ⅲ期35例,Ⅳ期29例,行喉全切除术40例,喉垂直部分切除术4例,喉声门上水平部分切除术15例,会厌切除术5例,所有病例均经5年随访。结果35例Ⅲ期喉声门上型癌患者中,行喉部分切除术和行喉全切除术者5年生存率分别为54.55%和56.72%,两者间无显著性差异(P>0.05);29例Ⅳ期喉声门上型癌患者中,行喉部分切除术和喉全切除术者5年生存率分别为46.88%和33.93%,两者间无显著性差异(P>0.05)。结论晚期喉声门上型癌行喉部分切除术是可行的,正确选择手术适应证,熟练掌握多种修复方法,可以提高晚期喉声门上型癌患者的生活质量。     

部分喉切除术治疗声门癌的疗效分析

为评价部分喉切除术治疗声门癌的效果，总结１９７４～１９９４年期间治疗声门癌患者１３２例，随访至１９９４年１２月，获得随访资料者１２６例（９５％），进行统计分析。所有病例均经组织病理学证实为喉癌，根据ＴＮＭ分期，Ｔ１、Ｔ２９８例（７７．８％），Ｔ３、Ｔ４２８例（２２．２％）。１例Ｔ４Ｎ１，其他均为Ｎ０。就诊时全部患者均为Ｍ０。１２６例患者均系采用部分喉切除治疗，其中８９例为单纯手术治疗，术前放射治疗４例，术后放射治疗３３例。应用Ｋａｐｌａｎ－Ｍｅｉｅｒ法进行生存率分析，结果１２６例中３年、５年和１０年生存率分别为９４．７％、８９．１％和８６．１％；Ｔ１、Ｔ２组３年、５年和１０年生存率分别为：９７．８％、９５．１％和９３．３％；Ｔ３、Ｔ４组为８３．２％、６２．７％和５２．３％。患者术后均保存了喉的发音功能，能用语言进行社交，喉功能恢复良好。结论：部分喉切除术是治疗声门癌的最佳选择。     

部分喉切除术治疗声门癌的疗效分析

为评价部分喉切除术治疗声门癌的效果，总结１９７４￣１９９４年期间治疗声门癌患者１３２例，随访至１９９４年１２月，获得随访资料者１２６例（９５％），进行统计分析。所有病例均经组织病理学证实为喉癌，根据ＴＮＭ分期、Ｔ１、Ｔ２ ９８例（７７．８％），Ｔ３、Ｔ４ ２８例（２２．２％），１例Ｔ４Ｎ１，其他均为Ｎ０，就诊时全部患者均为Ｍ０。１２６例患者均采用部分喉切除治疗，其中８９例为单纯手术治疗，术前放射治     

保留喉功能的T3声门癌的手术治疗

目的：探讨T3声门癌喉功能保留手术的方法和临床疗效。方法：对75例T3声门癌患者进行手术治疗，切除肿瘤后以会厌、双蒂接力肌甲状软骨膜瓣、颈阔肌皮瓣、胸骨舌骨肌筋膜瓣、颈阔肌筋膜瓣、甲状软骨膜瓣等修复组织缺损并重建喉功能。结果：全组病例3年生存率83．2％，5年生存率73．6％。62例患者于术后2周～6个月拔除气管套管，拔管率为82．7％。结论：T3声门癌在彻底切除肿瘤的前提下保留喉功能是可行的。熟练掌握多种修复方法，择优采用，是恢复良好的喉功能的重要保证。     

声门下癌的临床及其手术治疗

目的 探讨声门下癌的临床特点、手术和重建喉功能的方法及喉声门下部分切除术的可行性。方法 总结 １９８１￣１９９７年声门下癌１３例,Ｔ１－２Ｎｏ６例,Ｔ３Ｎｏ１例,Ｔ３－４Ｎ１－２６例。４例行全喉切除术,９例行喉声门下部分切除术和扩大喉声门下部分切除术（累及气管者）,分别以单侧或双侧皮瓣、肌筋膜瓣整复,喉腔内置“Ｔ”型硅胶管扩张,２￣６个月拨除。其中６例行颈清扫术。结果 除４例全喉切除术者外,余９例     

声门下癌的临床及其手术治疗

目的　探讨声门下癌的临床特点、手术和重建喉功能的方法及喉声门下部分切除术的可行性。方法　总结 1981～ 1997年声门下癌 13例 ,T1 2 N0 6例 ,T3N0 1例 ,T3 4N1 2 6例。 4例行全喉切除术 ,9例行喉声门下部分切除术和扩大喉声门下部分切除术 (累及气管者 ) ,分别以单侧或双侧皮瓣、肌筋膜瓣整复 ,喉腔内置“T”型硅胶管扩张 ,2～ 6个月拔除。其中 6例行颈清扫术。结果　除 4例全喉切除术者外 ,余 9例均恢复发音功能。 5例拔除气管套管 ,占 5 5 6% ,全部恢复吞咽功能。全喉切除和喉声门下部分切除术的 3、5年存活率分别为 10 0 %、66 7%和 88 9%、75 0 %。结论　对 4 0岁以上的男性声嘶患者应常规行纤维喉镜和动态喉镜检查 ,结合CT、MRI等 ,早期诊断是可能的。对大部分患者仍可行喉声门下部分切除术或扩大切除术。并提出对T3、T4者应酌情行颈清扫术。术后预防性放射治疗是必要的。     

喉环状软骨上部分切除术治疗喉声门上型癌

目的总结喉环状软骨上部分切除术治疗喉声门上型癌的疗效。方法对32例接受喉环状软骨上部分切除术(环状软骨舌骨固定术)治疗的喉声门上型癌病例进行随访和回顾性分析。结果本组T2、T3病例的3年生存率分别为85.7%(18/21)和66.6%(2/3),T2、T3病例的5年生存率分别为83.3%(5/6)和50%(1/2);所有患者术后都能发音,发音比较粗或沙哑,但能听懂;所有患者术后都有不同程度的误咽,经过练习96.8%的患者误咽克服,1例患者(3%)因术后始终无法克服误咽,改为喉全切除术;拔管率为100%。结论喉环状软骨上部分切除术手术操作简便,术后肿瘤学结果和功能结果满意,是治疗侵犯一侧或两侧声带的喉声门上型癌的有效术式。     

声门癌T3病变术后修复

为完善Ｔ３喉癌术后功能保全的方法，将会厌下位与残留甲状软骨板及环状软骨构成新喉软骨支架，双侧带状肌肌瓣修复术腔创面，形成声门的扩约作用。共行４０例。结果：重建的新喉发音清晰易辩，进食无明显呛咳，功能满意。３年生存率８２．５％（３２／４０），５年生存率７２．９％（２７／３７）。结论：会厌软骨及双侧带状肌瓣与喉为同一术野，血运良好，易于成活，可修复范围广泛，为理想的喉修复材料。     

Surgical treatment of T1-T2 glottic carcinomas

Transoral laser surgery (TLS) is a safe, time and cost-effective method of treatment for early stage glottic squamous cell carcinoma. This technique is more controversial in case of local extension to other subsite or in case of limited mobility.     

侵及前连合的声门型喉癌手术治疗

目的 探讨侵及前连合的声门型喉癌有效的手术方法.方法 回顾性分析侵及前连合的声门型喉癌T1～T3病变,行喉前淋巴结清扫、喉裂开声门上、下联合进路处理的37例完整临床资料.其中T1病变20例,T2病变7例,T3病变10例.采用Kaplan-Meier法计算术后生存率.结果 本组治疗后3个月全部拔除气管套管并恢复了吞咽和发...     

Surgical options in radiotherapy-failed early glottic cancer

After failure of curative radiotherapy (RT), surgery is the main therapeutic option to control recurrent laryngeal cancer. Recurrences after RT for T1–T2 tumours of the glottic larynx are often diagnosed at a more severe stage than the original disease and, thus, usually treated by radical approaches. Our aim is to investigate the feasibility of more conservative strategies for proper treatment of post-RT recurred glottic cancer. We collected and reviewed our files from 1990 to 2006, selecting 75 patients which matched the following inclusion criteria: (1) patient was originally diagnosed with early stage squamous cell carcinoma of the glottic larynx (stage I–II according to 2010 TNM), (2) patient was treated by RT with curative intent, (3) patient presented a recurrence of disease after RT which was surgically treated at our Institution. T stage at first diagnosis was T1a in 41 cases (55 %), T1b in 12 (16 %) and T2 in 22 (29 %). At clinical examination of RT-recurred lesions, we documented advanced lesions (rT3–rT4) in 29 out of 75 patients (39 %). Overall, an upstage was reported for 56 % RT-recurred cancers, while 37.3 % remained at the same stage than the original tumour and 6.7 % were downstaged. Twelve patients (16 %) underwent salvage partial laryngectomy (SPL), while 63 (84 %) received a salvage total laryngectomy (STL). Multivariate analysis showed that rTNM according to the AJCC-UICC of 2010 was the only prognostic factor for both disease-free survival (p = 0.042) and overall survival (p = 0.004). Considering the prognostic impact of rT and rN we documented a statistical significance only in terms of overall survival for both factors (p = 0.004 and p = 0.04, respectively). Although STL remains the most frequent treatment choice for failures after RT in laryngeal carcinomas, SPL represents a valid option for selected patients with limited recurrence and can deliver good oncologic and functional results if performed according to careful indications.     

The management of glottic T3 carcinoma

In the treatment of glottic T3 carcinoma there are four possible methods (1) primary radical surgery, (2) primary radical radiotherapy, (3) radical surgery with preoperative irradiation or (4) partial surgery. This study shows that patients treated primarily by surgery achieve worse results than those treated by radiotherapy.     

Selective management of early glottic cancer

Seventy patients with stage I and II glottic cancer were treated at the University of Utah School of Medicine hospitals from 1980 through 1987. Forty-four patients had stage I cancer and 26 patients had stage II. The overall survival in the stage I group was 82%. Primary site control was 93% with only three deaths due to laryngeal cancer. Local control rates were 93% with CO2 laser excision, 80% with CO2 laser and irradiation, and 67% with radiation alone. Stage II glottic patients had an overall survival of 61.5% with a local control rate of 76%. Twenty-one of 24 patients were treated by full-course irradiation. Of the eight patients who recurred at the primary site, all were irradiation failures who had initial bulky disease and impaired vocal cord mobility. Selective CO2 laser excision was highly effective, whereas radiation therapy results were somewhat disappointing. Open partial laryngectomy should be considered in bulky stage II disease patients.     

T1b声门型喉癌的治疗进展

T1b期无淋巴结转移声门型喉癌属于早期喉癌,病变累及双侧声带,可包括前联合或后联合.临床治疗方法主要包括放疗、内镜下治疗及手术等.通过复习相关研究资料,对T1b期声门型喉癌各种治疗方法及进展做一综述.     

Hyperfractionated radiotherapy for T2 glottic cancer for preservation of the larynx

To evaluate the effectiveness of hyperfractionation for T2 glottic cancer from a viewpoint of laryngeal preservation, we analyzed 21 patients (twice-a-day group) who were treated with hyperfractionation between 1992 and 1998 and compared the results with those of 27 patients (once-a-day group) treated with conventional once-a-day radiation between 1987 and 1992. In the twice-a-day group, radiation was performed with two fractions of 1.2 Gy/day up to a total dose of 72–74.4 Gy. In the once-a-day group, radiation was performed with a fraction of 2 Gy/day up to a total dose of 66 Gy. If radiation was ineffective at 40 Gy, it was stopped, and surgical treatment was carried out. Kaplan-Meier estimates were used for the analysis of the survival rate and laryngeal preservation rate, and the results were compared. In the once-a-day group, the 5-year survival rate was 92.3%. The 5-year laryngeal preservation rate was 51.8%, and it was 60.3% in 20 patients who had undergone full-dose radiation (once-a-day full-dose group). In the twice-a-day group, no major complication, such as laryngeal necrosis, was seen in any case, and the 5-year survival rate was 95.3%. The 5-year laryngeal preservation rate was 95.3%, and it was significantly better than that of both the once-a-day group and the once-a-day full-dose group. Hyperfractionation is considered to be useful for preserving the larynx for the treatment of T2 glottic cancer.