喉环上部分切除术及其疗效

目的 探讨喉癌行喉次全切除术并重建喉功能的术式及其疗效。方法 １９７８～１９９８年行喉次全切除环－舌骨固定术或环－舌骨－会厌固定术２９例,其中男１８例,女１１例;年龄最大７０岁,最小３８岁,平均５５．４岁。按１９８７年ＵＩＣＣ分期,全部均为Ｍ０,声门上型１０例（Ｔ２Ｎ０ ３例、Ｔ２Ｎ１ １例、Ｔ３Ｎ０ ３例、Ｔ３Ｎ１ ２例,Ｔ３Ｎ２ １例）,声门型１９例（Ｔ２Ｎ０ １２例、Ｔ２Ｎ１ １例、Ｔ３Ｎ０     

环状软骨上喉部分切除术嗓音的演化

目的：研究环状软骨上喉部分切除术后的嗓音声学特征。方法应用计算机言语实验室言语系统对５是否 状软骨上喉部分切除术的患者术后１８个月中嗓音及言语的演化过程进行前性研究。结果：环状软骨上部分切除术后患者发音参烽不稳定,而言语参数一直保持稳定。结论：在喉癌环状软骨上喉部分切除术中只保留一侧的杓状软骨,发音功能仍能保留。     

喉癌患者喉部分切除术后的嗓音声学分析

目的 探讨喉癌患者喉部分切除术术式、喉功能重建方法与术后嗓音质量的关系。方法 采用Dr．Speech嗓音分析软件，对116例不同术式喉部分切除术患者分别于术后1、2年进行发声功能测试，对测得的基频微扰（jitter）、振幅微扰（shimmer）、标准化噪声能量（NNE）进行比较分析，判断受试者嗓音质量。结果 所测得的声学参数jitter、shimmer、NNE值，以喉声门上水平部分切除术组最低，嗓音质量相对最好（P〈0．01）；喉次全切除术组最高，嗓音质量相对最差（P〈0．01）。声带切除术组和声带癌激光切除术组与其它各组比较，其差异均有显著统计学意义（P〈0．05或0．01），但这两组间比较，差异无统计学意义。各组术后嗓音质量效果从好到差依次为：喉声门上水平部分切除术组、声带切除术组、声带癌激光切除术组、喉垂直部分切除术组、喉额侧部分切除术组、喉次全切除术组。结论 喉癌患者喉部分切除术后，发声功能的恢复与手术方式及重建方法密切相关，其中，喉声门上水平部分切除术组术后嗓音质量相对最佳，喉次全切除术组术后相对最差。     

喉环上部分切除带蒂软骨膜环杓连接声门重建术后嗓音分析

目的:观察喉环上部分切除带蒂软骨膜环杓连接声门重建术与其他行喉部分切除术术后1年以上 患者的发声质量进行比较。方法:采用上海泰亿格电子有限公司提供的Dr.Speech嗓音及语音分析,测试在环境 噪声控制在45dB以下的实验室中进行。测试前受试者进行发声训练,测试声样选择元音[ ],评估参数为:基频 微扰,振幅微扰,噪声能量。结果:观察喉环上部分切除带蒂软骨膜环杓连接声门重建术嗓音各项声学参数值均 较正常值明显增高,差异有统计学意义;与其他喉部分切除术后相比,参数明显降低,发声质量明显提高。结论: 喉环上部分切除带蒂软骨膜环杓连接声门重建术提高了发声质量,嗓音声学分析可作为评价喉癌术后发声质量 的定量指标,有助于术后发声质量的客观评价。     

喉全切除术后应用电子喉与机械喉的声学参数比较

目的比较喉全切除术后应用电子喉与机械喉患者的声学参数异同,为无喉者的发音状况提供参数指标。方法选取喉全切除术后应用电子喉与机械喉患者分别为28例和30例,同时选取无嗓音病者24例作为对照组。测定发元音/a/时的声学参数,并进行比较。结果电子喉组与机械喉组相比较,各声学参数差异均无统计学意义（P均〉0.05）;而与健康组相比较,声时、最大声强、一口气节数、基频以及振幅无显著性差异,基频微扰、振幅微扰、标准化噪声能量和谐噪比有显著性差异（P均〈0.05）。结论电子喉组的发音声学特征与机械喉组相近,与健康组相比均有显著性差异。机械喉音的音调、音色、音质优于电子喉。     

环状软骨上部分喉切除术后言语功能的声学及气体动力学测定

环状软骨上部分喉切除术（SCPL）适用于治疗T2及部分T3声门癌和声门上型喉癌。术中可切除声带、前联合、会厌根部及假声带，但杓状软骨必须保留。SCPL的优点在于肿瘤控制率高（＞80％），并且95％的病例能保留喉功能。关于SCPL后病人发音方面的研究报道很少，本通过将客观检测数据与主观评估相比较，对SCPL后病人的发音特点做前瞻性研究。     

喉部分切除术后患者的嗓音功能观察

目的 研究喉癌患者喉部分切除术后嗓音功能情况及变化趋势,以探讨不同术式与患者术后嗓音质量的关系.方法 应用计算机嗓音声学测试系统(Dr.Speech Science for Windows软件,美国泰亿格公司产品)对30例正常对照者及55例喉部分切除术患者(其中喉声门上水平部分切除术组20例,喉垂直部分切除术组18例,喉扩大垂直切除术组17例),于术后5年内不同时间进行嗓音声学测试,并对所测得的平均基频(F0)、基频微扰(jitter)、振幅微扰(shimmer)、标准化噪声能量(NNE)、第一共振峰频率(F1)、第二共振峰频率(F2)进行比较分析.结果 三种术式F0均较正常对照组低,jitter、shimmer、NNE均较正常对照组高.jitter、shimmer、NNE数值由低到高排列依次为喉声门上水平部分切除术组、喉扩大垂直切除术组、喉垂直部分切除术组.喉声门上水平部分切除组/a:/、/i:/、/u:/的第一共振峰频率明显高于正常对照组.结论 喉水平部分切除术后嗓音功能恢复最佳,而喉垂直部分切除术后最差.嗓音声学分析可作为评价喉癌术后发声质量的定量指标,有助于针对性地指导患者术后嗓音康复训练.     

Feasibility of supracricoid laryngectomy based on pathological examination

Partial horizontal supracricoid laryngectomy with cricohyoidopexy at the Department of Otolaryngology, Medical University of Białystok, involves resection of the entire thyroid cartilage with the pre-epiglottic and paraglottic spaces. Experience has shown that this technique will permit adequate phonation, respiration and deglutition in selected advanced cases of supraglottic and glottic carcinoma. The purpose of this study was to verify histologically the indications for this surgery by examining sections of whole-organ laryngeal specimens. Post-laryngectomy specimens from 90 patients with otherwise previously untreated supraglottic (48), transglottic (22) and glottic (20) carcinomas were reviewed retrospectively. The majority (66) of the specimens were staged as pT₄. Findings showed that 22 of the specimens analyzed (mostly supraglottic tumors) could have been eradicated by supracricoid laryngectomy alone. The present study confirmed the principles of supracricoid laryngectomy for selected large tumors. Received: 4 June 1997 / Accepted: 23 September 1997     

Analysis of clinicopathological stage in supracricoid partial laryngectomy patients: Need for adjuvant therapy in clinically understaged cases

Objective

The aim of this study is to evaluate the impact of pre-operative T-understaging on clinical outcome in supracricoid partial laryngectomy (SCPL).

Methods

The medical records of 92 patients who underwent SCPL were evaluated. By comparing clinical and pathologic stages, the causes of pre-operative T-understaging and its relationship with local recurrence and survival were examined.

Results

Fifteen patients (16.3%) were found to be underestimated in terms of pre-operative T-stage, primarily due to failure to identify thyroid cartilage invasion (11 cases). Among these, radiation treatment at the primary site was offered in only two cases, including one case with a positive surgical margin. Among 82 patients followed for over 1 year, local recurrence occurred in seven patients (8.5%); five of these (71.4%) had been understaged pre-operatively due to failure to detect thyroid cartilage invasion. The local recurrence rate was higher and the overall survival rate was lower in patients who were understaged pre-operatively, compared to those who were staged accurately (p = 0.006 and p = 0.001, respectively).

Conclusion

SCPL should be conducted only after a thorough pre-operative evaluation in locally advanced laryngeal cancer. Additionally, adjuvant treatment is necessary to reduce local recurrence in cases where thyroid cartilage invasion is determined pathologically after SCPL.     

Prognostic evaluation in supracricoid partial laryngectomy with cricohyoidopexy

Identification of prognostic factors related to supracricoid partial laryngectomy may optimise indications for this surgical technique. We analysed several clinical and histopathological variables in a series of 81 patients treated with SPL at our department. Attention was focused on neoplastic spread of the anterior commissure, thyroid cartilage and prelaryngeal soft tissue of the neck. Statistical analysis (Kaplan-Meier method and Cox regression test) showed a significant decrease in survival for prelaryngeal soft tissue invasion. Due to the fact that the survival rate is not modified by the anterior commissure and thyroid cartilage infiltration, the prognostic value of prelaryngeal invasion is extremely relevant. Therefore, we suggest the oncological value of SPL even in cases of invasion of the anterior commissure or thyroid cartilage, but not beyond the outer perichondrium.     

Successful 10-year outcomes after supracricoid partial laryngectomy for selected glottic squamous cell carcinoma classified as T3N0M0: A STROBE analysis

PurposeTo evaluate long-term oncological outcome for patients with selected glottic squamous cell carcinoma (SCC) classified as T3N0M0 treated by supracricoid partial laryngectomy (SCPL).Materials and methodsAnalysis of an inception cohort of 46 patients with isolated untreated SCC classified as T3N0M0 and minimum 10-year follow-up, consecutively treated by SCPL between 1982 and 2012 in a French university teaching hospital. The main endpoint was 5- and 10-year actuarial survival and local control estimates. Accessory endpoints comprised cause of death, screening for variables decreasing survival and increasing risk of local recurrence, oncologic consequences of local recurrence, and laryngeal preservation rate.ResultsFive- and 10-year actuarial survival was 78.1%, and 53.3%, respectively. The main causes of death were intercurrent disease and metachronous second primary, each in 33.3% of cases. Postoperative mortality (aspiration pneumonia) was 2.1%. There were no significant correlations between survival and any study variables. Five- and 10-year local control was 90.5%. Overall local recurrence varied significantly (P = 0.003), from 2.3% with negative margins (R0) to 100% with positive margins (R1) and/or dysplasia. Local recurrence was associated with a significantly (P < 0.005) increased risk of nodal failure and distant metastasis, and reduced survival. Overall laryngeal preservation was 89.1%.ConclusionThe present results suggest that SCPL should continue to be taught and that this type of partial laryngeal surgery should be included in the various organ-sparing strategies considered in advanced laryngeal cancer.     

Thyroid gland flap minimizes mucosal defects at supracricoid partial laryngectomy with cricohyoidoepiglottopexy

Wound infection is a major complication after supracricoid partial laryngectomy with cricohyoidoepiglottopexy (CHEP) for radiation therapy failure. A 60-year-old man received chemoradiotherapy for a glottic carcinoma. CHEP, reusing the thyroid gland flap (TF), was performed because the cancer recurred after a salvage vertical partial laryngectomy following radiation therapy failure. The TF was sutured to the supraglottis and cricoid cartilage mucosa to minimize mucosal defects before the hyoid bone and cricoid cartilage were sutured. Wound healing after CHEP was good without infection. After decannulation, oral food intake was possible without aspiration, and speech function was comparable to that of other patients who had supracricoid partial laryngectomies. Histopathological examination revealed a close connection between the TF and its surrounding tissues without fibrous scarring. TF may improve wound healing after CHEP for radiation failure by minimizing mucosal defects.     

扩大喉环状软骨上部分切除及喉功能重建术

目的:对扩大喉环状软骨上部分切除及喉功能重建术的手术方法、适应证及喉功能恢复情况等进行探讨。方法:2000~2005年对10例向声门前下侵犯达10~20mm的T3、T4喉癌患者施行扩大环状软骨上部分喉切除及喉功能重建术。结果:9例患者均无瘤生存并仍在随访中,1例患者术后4年颈部转移癌复发死亡。所有患者术后均恢复了正常的呼吸、吞咽及维持声门下压的功能,术后发声也令人满意。结论:只要严格掌握手术适应证,对部分向声门前下侵犯达10~20mm的喉癌患者实施治疗,该术式确实能取代全喉切除术。     

Laryngeal preservation with supracricoid partial laryngectomy results in improved quality of life when compared with total laryngectomy

OBJECTIVES/HYPOTHESES: Study 1: To assess the oncologic outcome following supracricoid partial laryngectomy (SCPL). Study 2: To compare the quality of life (QOL) following SCPL to total laryngectomy (TL) with tracheoesophageal puncture (TEP). Study 3: To analyze whole organ TL sections to determine the percentage of lesions amenable to SCPL STUDY DESIGN: Study 1: A retrospective review of patients who underwent SCPL. Study 2: A non-randomized, prospective study using QOL instruments to compare patients who underwent either SCPL or TL Study 3: A retrospective histopathologic study of TL specimens assessed for the possibility of performing an SCPL. METHODS: Study 1: Twenty-five patients with carcinoma of the larynx underwent SCPL between June 1992 and June 1999. Various rates of oncologic outcome were calculated. Study 2: Thirty-one patients participated in the QOL assessment. This included the SF-36 general health status measure, the University of Michigan Head and Neck Quality of Life (HNQOL) instrument, and the University of Michigan Voice-Related Quality of Life (VRQOL) instrument. Study 3: Ninety surgical specimens were obtained and studied from the total laryngectomy cases in the Tucker Collection. Multiple sites were evaluated for the presence of carcinoma A computer program was written to classify whether the patient was amenable to SCPL. RESULTS: Study 1: The overall local control rate was 96% (24/25). The local control rate following SCPL with cricohyoidoepiglottopexy (CHEP) was 95% (20/21). The local control rate following SCPL with cricohyoidopexy (CHP) was 100% (4/4). Study 2: The SCPL had significantly higher domain scores than TL and TEP in the following categories for the SF-36: physical function, physical limitations, general health, vitality, social functioning, emotional limitations, and physical health summary. The significantly higher domains for the SCPL when compared with the TL and TEP for the HNQOL were eating and pain. Finally, when voice-related QOL was assessed with the V-RQOL, the domains of physical functioning and the total score were significantly better with SCPL when compared with TL and TEP. Study 3: Forty of 90 (44%) laryngeal whole organ specimens were determined to be resectable by SCPL. In 16 (18%) specimens, the patients could have undergone SCPL with CHEP and in 24 (27%) specimens the patients could have undergone SCPL with CHP. Among the 40 (44%) specimens determined to be able to have undergone SCPL, 19 were glottic (1 T1, 15 T2, 3 T3) and 21 were supraglottic (9 T2, 12 T3). CONCLUSIONS: 1) A review of the literature and an analysis of the data in this study indicate that excellent local control may be expected following SCPL. 2) The QOL following SCPL, as measured by three validated QOL instruments, is superior to TL with TEP. 3) A histologic assessment of whole organ sections of TL specimens indicates that many patients who have been subjected to TL may have been candidates for SCPL. 4) If the indications and contraindications are rigorously adhered to, SCPLs are reasonable alternatives to TL in selected cases.