喉部分切除术后10年疗效回顾性观察

喉全切除术的弊端是术后病人完全丧失说话能力成为无喉人,而近年来喉部分切除术为喉功能的保存与恢复提供了新的治疗方法.喉部分切除术是根据喉的解剖、组织发声原理,按肿瘤的原发部位及侵犯区域,在彻底切除肿瘤的前提下保留安全范围的健康组织,有利于喉功能的恢复.自20世纪后期喉部分切除术已广为喉癌患者及医生们所接受.病人能经口呼吸、发音是提高患者术后生存质量的最重要的标志,也是喉全切除术所不能达到的.本文对10年间我院收治的有完整随访资料的174例行喉部分切除术喉癌患者的生存率、拔管率、复发率进行分析,探讨各种喉部分切除术的远期疗效。     

无需气管切开的喉软骨窗式喉部分切除术治疗早期喉癌疗效观察

目的探讨无需气管切开的喉软骨窗式喉部分切除术的疗效。方法对24例早期喉癌患者（声门上型2例,声门型22例）,行不做气管切开的喉软骨窗式喉部分切除术。结果术后2~3 d恢复经口饮食,发音清晰;1例术后第2天因呼吸困难行气管切开,7例出现颈胸部皮下气肿,经加压包扎或皮下放置负压引流管,出院前均消失,无其他并发症。术后随访2个月~3 a,1例肺转移死亡,其余均健在。结论无需气管切开的喉软骨窗式喉部分切除术是治疗早期喉癌的理想方法。     

喉全切除术后二期气管食管裂隙状瘘发音重建术效果观察

目的恢复喉全切除术后患者发音功能。方法对224例喉全切除患者行二期气管食管裂隙状瘘发音重建术,对合并颈前瘢痕而影响下咽食管上段气流顺利通过者行颈前瘢痕松解,术后随访观察发音及吞咽情况。结果 224例患者术后均能发音,其中发音优良者占96.4%（216/224）。105例患者存有不同程度的误咽,30例中重度误咽患者中12例利用颞肌筋膜封闭气管食管瘘孔,4例利用颞肌筋膜或局部缝合缩小气管食管瘘孔,2例放置发音钮。结论二期气管食管裂隙状瘘发音重建术是喉全切除后患者恢复言语功能的有效术式,操作简便,术后即可发音。对影响下咽及食管上段气流顺利通过的颈前瘢痕同期予以松解,可有效提高发音成功率。术后误咽是最常见的并发症,经简单干预多可基本控制,必要时可手术治疗。     

喉部分切除术治疗喉癌12例疗效分析

1990年 6月～ 2 0 0 0年 6月 ,我们采用喉部分切除手术治疗喉癌患者 1 64例 ,其中 1 42例获随访资料 ,现报告如下并分析其疗效以及术后喉功能恢复情况。1　资料与方法1 .1　一般资料　本组男 1 2 8例 ,女 1 4例 ;年龄 3 0～78岁 ,平均 5 4.8岁 ;病理诊断为鳞状细胞癌 1 2 5例(88% ) ,疣状癌 8例 (5 .6% ) ,乳头状癌 5例 (3 .5 % ) ,平滑肌肉瘤 3例 (2 .1 % ) ,菱形细胞癌 1例 (0 .8% )。根据国际抗癌协会 (UICC) 1 987对头部恶性肿瘤的TNM分期标准进行临床分期 :T1 N0 M0 期者 3 4例(2 3 .9% ) ,T2 N0 M0 期者 67例 (4 7.3 % ) ,T3N0 …     

135例喉癌行喉部分切除术后的疗效分析

对资料完整的１３５例喉部分切除术后的喉癌患者进行了疗效分析，统计了各期喉癌的术后３年、５年生存率，并对术后喉功能的恢复情况进行了讨论，提出喉癌行喉部分切除术后的疗效分析应包括术后生存率和喉功能恢复两个方面。     

喉部分切除喉功能重建术治疗中、晚期喉癌

目的 探讨喉部分切除喉功能重建术治疗中、晚期喉癌的可行性。方法 对205例中、晚期喉癌患者行喉部分切除术。同期分别采用颈前肌皮瓣、颈前带状肌肌筋膜瓣、会厌瓣、会厌瓣＋颈前带状肌肌筋膜瓣、舌骨肌瓣修复喉缺损。结果 术后128例拔除气管套管，203例保留了发音功能。患者术后3、5年生存率分别为76．1％、64．7％。结论 喉部分切除喉功能重建术治疗中、晚期喉癌可在不降低患者生存率的基础上基本保全发音功能。     

老年人喉癌喉切除术的疗效分析

目的探讨老年喉癌患者行喉切除术的疗效和可行性。方法回顾性研究上海交通大学医学院附属第九人民医院奉城分院耳鼻咽喉科和上海交通大学医学院附属第九人民医院耳鼻咽喉科自1996年至2009年的122例60岁及以上的接受各种喉切除手术的老年人喉癌患者,其中男117例,女5例;年龄60～94岁,中位年龄68岁;95例（77．9％）患者有全身合并症。按2002年国际抗癌联盟（international union against cancer,UICC）标准,I期16例,Ⅱ期24例,Ⅲ期52例和Ⅳ期30例。在彻底切除病变的基础上,尽量保留喉的正常组织和喉的功能,切除时保留安全缘≥5mm。采用三种手术方式：经口支撑喉镜显微镜下激光喉癌切除术（10例）、喉部分切除术（25例）和全喉切除术（87例）,同时参照2004年大连会议标准行颈淋巴结清扫术。结果122例患者术后伤口I级愈合114例（占93．4％）;Ⅱ级愈合5例;Ⅲ级愈合3例,其中2例发生咽瘘,经积极换药的处理和营养对症支持治疗,2w后创面愈合。所有患者进食均无困难,围手术期均无合并症的加重与恶化。本组1、3、5年随访率分别为100％（122／122）、97．2％（106／109）、92．9％（91／98）,采用直接法统计生存率,失访按死亡计算;1、3、5年生存率97．5％（119／122）、84．4％（92／109）、68．4％（67／98）。结论老龄不是喉癌患者行喉切除术的禁忌证,在有充分的术前准备、严格掌握适应证和积极的围手术期处理的前提下,手术仍是治疗老年喉癌患者的主要手段。     

70岁及以上喉癌患者的喉功能保全手术治疗

目的 分析70岁以上老年喉癌患者行喉功能保全手术的方法及疗效. 方法 136例原发喉癌患者,行声带切除34例,垂直半喉切除28例,喉声门上水平部分切除24例,喉3/4切除15例,次全喉切除29例,全喉切除环咽吻合术6例.T3-4期病灶切除后多采用颈部肌皮瓣修复.术后可在气管套管外放置麻醉气囊,练习进食. 结果 全部患者术后1周均恢复发音功能,92例拔除气管套管.45例有不同程度呛咳,经过吞咽练习后好转,1例失败.围手术期无死亡.3年和5年生存率分别为78.7%和68.5%. 结论 对70岁以上老年喉癌患者,术前评估准确、术式选择和围手术期处理得当,可行喉功能保全.     

喉次全切除术在晚期喉癌中的应用与评价

临床上治疗晚期喉癌往往实行全喉切除术,使患者失去发音功能.Pearson报告对T3喉癌患者施行近全喉切除术,既切除肿瘤又保留患者的发音功能,效果满意[1].现结合我院对23例T3喉癌患者施用Pearson手术的经验做以下评价.     

喉切除术对喉癌患者生存质量的影响

目的探讨喉切除术对喉癌患者生存质量的影响。方法对20例行喉切除术的喉癌患者于术前和术后2周应用欧洲癌症研究和治疗组织生存质量核心调查表C30及头颈部肿瘤调查表H＆N35（EORTC QLQ-C30/H＆N35）中文版进行生存质量评估。结果喉癌患者术前与术后2周在躯体功能、角色功能、社会功能、疲倦、疼痛、感觉问题、语言问题、社交障碍、性功能减退、张口问题、咳嗽、补充营养、进食管方面等有显著差异（P〈0.05、0.01）。结论喉切除术可导致喉癌患者术后生存质量下降,术后医务工作人员及家属应尽早行相关干预,以提高患者的生存质量。     

Deglutition after supracricoid laryngectomy: Compensatory mechanisms and sequelae

This study is based on the videofluorographic exploration of deglutition in 14 patients who were treated by supracricoid laryngectomy. The choice of this population rests on two criteria: a 1-year postoperative delay, and absence of residual deglutition disorders elicited by patient history. Asymptomatic aspiration was seen in 6 cases. In the cricohyoidoepiglottopexies (CHEP), aspiration occurred uniquely in patients who did not recuperate satisfactorily from epiglottic dynamics. The deglutition sequelae are less invalidating relative to the cricohyoidopexies (CHP), with a possible recuperation of the dynamic sequence of the pharyngeal swallow. On the other hand, in the CHP, a complete reorganization of the stepwise sequence of the different neuromuscular events is necessary.     

Staple closure of the hypopharynx after diverticulectomy and total laryngectomy

The use of stapling devices to close hypopharyngeal defects was first published in 1969 but the technique does not seem to have gained much popularity among head and neck surgeons. Fifty-nine hypopharyngeal defects were closed using a linear stapler between January, 1984, and April, 1989, at the Department of Otolaryngology, Head and Neck Surgery of the University Hospital of Zurich. Twenty closures were performed following resection of hypopharyngeal diverticula, 39 following wide field laryngectomy. A total of 10 salivary fistulae was observed: 2 after diverticulectomy (10%), 3 after laryngectomy in nonirradiated patients (11%), and 5 after laryngectomy in irradiated patients (45%). These fistula rates are comparable with average rates quoted in the literature. Only after laryngectomy for radiation failure was the fistula rate unusually high. No other complications were seen that could have been attributed to this type of pharyngeal closure. Closure of a hypopharyngeal defect with a stapler is easier and faster than with traditional suture methods. Provided the patient has not been previously irradiated, staple closure of the hypopharynx appears to be as reliable as closure by standard techniques and can be safely recommended.     

The effect of extrahepatic cholestasis on liver regeneration after partial hepatectomy in the rat

Abstract: Liver regeneration after partial hepatectomy was studied in four groups of rats: control rats (n=12), rats with 1 week of common bile duct obstruction (n=11), rats with restoration of bile flow after 1 week of obstruction (n=9) and a sham-operated group (n=7). Parameters of DNA synthesis – thymidine kinase activity and in vivo bromodeoxyuridine incorporation – were measured at partial hepatectomy (T=0), and 24 and 48 h after partial hepatectomy. During common bile duct obstruction, DNA synthesis was already stimulated at T=0, but partial hepatectomy in common bile duct obstruction rats induced a delayed DNA synthesis. After 1 week of restoration of bile flow, normal DNA synthesis had returned at T=0, but DNA synthesis after partial hepatectomy was still delayed. The sham-operated rats showed a normal regeneration response after partial hepatectomy assessed by bromodeoxyuridine incorporation but delayed as assessed by thymidine kinase activity, partly due to the impaired physical condition of the animals. The present data support the hypothesis that during cholestasis, regeneration promoting, and inhibitory factors accumulate in the liver, their balance determining whether regeneration after partial hepatectomy will occur in a normal, enhanced or delayed way.     

A retrospective study of the preventive effect of transarterial chemotherapy for intrahepatic recurrence of hepatocellular carcinoma after partial hepatectomy

A major problem in treating hepatocellular carcinoma (HCC) is intrahepatic recurrence after partial hepatectomy, despite the relatively early detection now possible due to recent developments in non-invasive diagnostic modalities. The present study evaluated the usefulness of preventive therapy for intrahepatic recurrence of HCC. In order to suppress intrahepatic recurrence in HCC patients at high risk of recurrence after tumor removal, we performed preventive transarterial chemotherapy in 23 such patients. Doxorubicin, at a dose of 0.5 mg/kg body weight, was administered, via a catheter inserted at the junction of the common hepatic artery and the gastroduodenal artery, every 2 weeks for the first 2 months, and every month thereafter for at least 1 year. The control group consisted of 30 patients with similar risk of recurrence who underwent partial hepatectomy during the same period without receiving transarterial preventive therapy. The 1-, 2-, 3-, and 5-year cumulative cancer-free survival rates in patients who received transarterial preventive chemotherapy after partial hepatectomy were 87.0%, 47.1%, 21.2%, and 21.2%, respectively, compared to 53.3%, 30.0%, 20.0%, and 13.3%, respectively, in the control group (P<0.05). The 1-, 2-, 3-, and 5-year cumulative overall survival rates were 95.7%, 81.2%, 58.4%, and 48.7%, respectively, in the preventive chemotherapy group, compared to 70.0%, 49.4%, 41.7%, and 19.5%, respectively, in the control group (P<0.05). Thus, the present study demonstrates the limited but significant effect of preventive transarterial chemotherapy for the intrahepatic recurrence of HCC after partial hepatectomy.     

两组全麻药在支撑喉镜下声带小结摘除术后清醒效果对比

目的 探讨应用全凭静脉复合全麻完成支撑喉镜下声带小结摘除术后,两组患者的复苏清醒效果的对比.方法 66例声带小结患者随机分成A、B两组,每组33例,A组选用全麻药物为芬太尼、丙泊酚、咪达唑仑做全麻诱导;B组选用全麻药物为芬太尼、丙泊酚、利多卡因做全麻诱导,肌松药物均使用阿曲库铵.插管后静脉维持药物均使用丙泊酚、芬太尼微泵注射,手术结束时停药.结果 两组麻醉效果相同,B组患者清醒时间比A组快,清醒彻底,无嗜睡现象,术后拔管时间快.结论 在支撑喉镜下声带小结摘除术中使用咪达唑仑会影响术后患者清醒时间,有嗜睡现象,加用多沙普伦可改善这一现象,加快患者清醒速度.     

Plasma-kallikrein clearance during liver regeneration after partial hepatectomy in the rat

Abstract: Aims/Background: The liver clears circulating plasma-kallikrein through a receptor-mediated endocytosis process: an initial fast phase is followed by a slow exponential phase. Methods: To determine whether the clearance rate of plasma-kallikrein is affected during liver regeneration, we perfused isolated rat livers with rat plasma-kallikrein (rPK) at 0, 1, 2, 3 and 7 days after partial hepatectomy or sham operation. Results: Liver regeneration was followed by the expression of the proliferating-cell nuclear antigen (PCNA) labeling index. The serum concentration of α₂-macroglobulin, an acute phase protein in rats, was measured. At day 1, the fast phase of rPK clearance rate increased in hepatectomized rats when compared with day 0 (4.9±0.4 and 3.7±0.4 mU/g liver · min, p<0.05). However, at day 2, the rPK fast phase clearance rate dropped significantly (2.6±0.2, p<0.05), when compared with day 1. No difference was found among the sham groups at different days of hepatectomy. These changes seem to be independent of the acute phase reaction. The regenerative liver weight increased continuously during the observation period. PCNA expression increased significantly after hepatectomy, with maximal PCNA-labeling indices at days 1 and 2, declining thereafter. Conclusion: The rPK fast phase clearance rate changes during liver regeneration, with a zenith occurring when PCNA labeling index is maximal (day 1) and a nadir occurring at the mitotic phase (day 2).     

Risk of gastric cancer is not increased after partial gastrectomy

BACKGROUND: It has been suggested that there is an increased risk of gastric cancer following partial gastrectomy. This question has not been studied in an Australian population. METHODS: The records of a total of 569 patients who had a partial gastrectomy for peptic ulcer disease at Repatriation General Hospital, Heidelberg, between 1957 and 1976 were reviewed. All were followed to date of death or 31 December 1996. The expected rate of gastric cancer for this population was estimated from published Australian age-and sex-specific gastric cancer mortality rates over this period, and a standardized incidence ratio was calculated. RESULTS: The mean age at surgery was 53.5 years (range 27-83 years). There were 547 male (96.4%) and 22 female (3.6%) patients. Five hundred and seven (83.5%) had a Billroth II procedure. Thirty-eight patients (6.3%) were lost to follow up and were not included in the analysis. From the records of the Department of Veterans' Affairs, it was established that 125 (20.6%) were alive in December 1996, a mean survival after surgery of 18.8 years. The mean documented duration of follow up was 17.3 years (range 1-41 years). Nine patients developed cancer in the gastric remnant. The expected number of cancers in this population was 6.5. Assuming all survivors were free of gastric cancer, the standardized incidence ratio was 1.39 (95% confidence intervals 0.64-2.65, P=0.313). CONCLUSION: The risk of gastric cancer was not increased after partial gastrectomy in this Australian population.