自制加长电刀在功能性喉微创手术中的应用

目的探讨自制加长电刀在支撑喉镜下行功能性喉微创手术的应用价值，以及手术方法。方法对38例常见喉部疾病的住院患者，在全麻显微支撑喉镜下，应用自制加长电刀行喉部病灶切除术。结果7例早期声带癌患者，1例术后1年局部复发，再行垂直半喉切除术，随访至今（2年）未见复发；其余6例未见局部复发和淋巴结转移。31例良性病变及癌前病变患者均一次手术成功。     

保留声带黏膜的喉微创手术

目的研究全麻下喉微创手术治疗声带良性病变的疗效及优点.方法使用支撑喉镜、显微镜及喉显微手术器械切除病变尽量保护声带黏膜,以使术后发声复原.结果36例中30例术后1周声嘶基本消失,随诊6个月至1年未出现复发.结论气管插管全麻下行保留声带黏膜的喉微创手术,能够更好地保护未发生病变或仅有轻度病变的声、室带黏膜.术后能较早地恢复正常的声、室带生理功能,减少复发,并发症少.     

喉内镜手术治疗喉部疾病的临床应用--介绍一种喉部微创外科技术

目的：探讨新的治疗喉部疾病的微创外科技术--喉内镜手术的临床应用价值。方法：使用从德国STORZ公司新引进的国内首套喉内镜手术系统，治疗包括声带小结、声带息肉、喉乳头状瘤、声带囊肿、会厌囊肿、喉部炎性假瘤、喉部血管瘤等55例病人，并随访2-14个月。结果：55例病人，发音恢复正常者51例，发音功能明显好转者4例。术后1个月动态喉镜检查见所有病人声带粘膜光滑，声带活动及闭合良好，粘膜波正常。结论：喉内镜手术视野广、直接、清晰、照明度高，使手术在微创的前提下彻底清除病灶并最大限度地保留功能，特别是可以避免对喉部良性肿瘤、癌前病变、声带微小癌及喉狭窄等多种喉部疾病采用喉裂开术，有很好的临床推广使用价值。     

嗓音显微外科技术的临床应用

目的 对于喉部病变，在得到有效治疗的同时，最大限度地保留正常和高质量的发声功能。方法 1986－2000年中日友好医院耳鼻咽喉科应用嗓音显微外科技术治疗1153例喉部疾病。根据喉部各种良性病变（声带小结、声带息肉、Reinke水肿、声带囊肿等）和不同阶段早期恶性病变及声带癌前病变侵犯的组织学深度，分别采用显微切除技术、外侧微瓣技术、内侧微瓣技术、黏膜下注射技术、黏膜剥脱及激光切除术等，切除病变组织，最小伤及正常组织和对发音质量的影响。结果 1044例（99．8％）声带小结、声带息肉、声带囊肿和12例Reinke水肿在通过显微切除技术、外侧微瓣技术、内侧微瓣技术等治疗后均能在1周后获得正常发音，2例巨大声带息肉患者半年内声嘶改善不满意；20例Reinke水肿、31例癌前病变经黏膜剥脱及黏膜表皮剥脱处理，除3例癌前病变术后复发又经2、3次手术，其余均在1－3个月内恢复正常发音。34例声带癌经黏膜剥脱处理，5例声带癌和5例喉乳头状瘤经激光切除，术后5年以上随访5例声带癌复发，其中2例再次行黏膜剥脱术，1例乳头状瘤反复4、5次手术。治疗后的发音效果均比经颈部切除手术好。结论 嗓音显微外科技术是彻底治疗喉部疾病同时可以最大限度保留声带发声功能的重要手术方法。     

支撑喉镜联合喉内镜及电动切削器治疗喉良性病变

目的评价支撑喉镜联合喉内镜监视系统及电动切削器治疗喉良性病变的疗效。方法对60例喉良性病变患者在支撑喉镜及监视摄像系统下应用电动切削器进行手术治疗。结果60例患者术后随访1年,4例广基型声带息肉因术后用声不当及2例喉乳头状瘤在3个月内复发,行再次手术,其余患者随访1年无复发。结论支撑喉镜联合喉内镜和电视监视摄像系统使喉部图像及手术视野尤其Reinke’s间隙更为清晰,病灶可以彻底切除,同时应用电动切削系统能更加简单、快捷、准确切除声带病变,并能保护好声带正常组织。     

支撑喉内镜联合动力系统在喉微创手术中的临床疗效

目的 探讨支撑喉内镜下联合喉动力系统在喉微创手术中的临床疗效。方法 声带病变患者215例,在支撑喉内镜数字显像系统的监视下,与动力系统驱动下的切割刀头联合运用切除声带病变,观察临床疗效并对手术前后临床检查结果以及患者嗓音障碍指数（VHI-10）进行比较。结果 215例声带病变一次切除,全部手术过程顺利,术后随访发现患者发音功能得到很好的恢复,声嘶改善满意。手术前后VHI量表评分变化有统计学意义（P<0.05）。结论 支撑喉内镜数字显像系统联合动力系统可以常规应用于喉微创手术中,具有相对安全、视野清晰、操作精确、创伤小等优点,疗效满意。     

鼻内镜在困难性支撑喉镜下声带手术中的应用

鼻内镜手术已成为临床上较为成熟的一项技术 ,其适应证也已从以前的鼻窦炎的治疗扩展到颅底、眼眶等疾病的手术治疗。我们利用不同角度的鼻内镜对支撑喉镜下声门暴露不良的声带良性病变进行了手术 ,取得了较好的效果 ,现总结如下。1　资料与方法1998年至 2 0 0 1年间我科在支撑喉镜 +鼻内镜直视下 ,进行声带良性病变手术 ,共 2 1例 ,其中男性 11例 ,女性 10例 ;年龄 2 8～ 70岁 ,平均 4 3.6岁 ;病程 1个月～ 10年不等 ;就诊时主诉以间歇性声嘶、渐进行声嘶及长期声嘶为主要症状 ;术前间接喉镜或纤维喉镜检查 :单侧声带新生物 18例 ,双侧声带…     

纤维喉镜在喉部病变诊断和治疗中的应用

目的分析纤维喉镜在喉部病变诊断和治疗中的应用价值。方法回顾总结1998年以来在纤维喉镜下对326例喉部病变患者进行检查及手术治疗的临床资料。结果 326例中声带息肉173例,声带小结139例,占95．66％,均在纤维喉镜下行手术治疗,术后声嘶消失285例,27例经二次手术后辅助治疗声嘶消失,随访6个月未复发;喉淀粉样变5例,喉结核7例,声带癌2例,纤维喉镜下取活检,确诊后行相关治疗。结论应用纤维喉镜可明确喉部病变的诊断,对部分良性病变可进行治疗。     

早期声门癌部分喉切除与氩气刀治疗的疗效比较研究

目的比较支撑喉内镜下氩气刀微创手术与部分喉切除术治疗早期声门癌的临床疗效。方法 2008年1月~2013年5月我科治疗的早期喉癌(声门型,T_1-T_2N_0M_0)32例,于支撑喉内镜下实施氩气刀微创手术14例作为治疗组,另18例接受常规部分喉切除术者作为对照组。术后随访3~5年,比较两组的疗效。结果治疗组术后平均住院天数为7.6±1.8天,明显短于对照组的15.5±3.6天(P0.05),并避免了气管切开,喉功能保留良好,术后恢复快。两组术后复发情况比较无明显差异,3年生存率和5年生存率相似。结论氩气刀与支撑喉内镜技术相结合治疗早期声门癌远近期疗效均肯定,喉结构和功能保留较好,值得临床推广。     

全麻支撑喉内镜微创手术结合中药治疗咽喉部病变临床研究

目的 观察全麻下支撑喉内镜微创外科手术结合中药咽喉宁综合疗法治疗咽喉部病变的疗效优势.方法 对2004年1月～2007年12月在本科接受全麻下支撑喉内镜微创外科手术为主结合中药咽喉宁综合疗法治疗的咽喉部病变患者154例进行回顾性研究,总结疗效优势,分析其技术优缺点.结果 所有病例均随访半年以上,总有效率为96.75%.结论 全麻下实施支撑喉内镜微创外科手术结合中药治疗咽喉部病变疗效好,具有操作方便、创伤小、手术精度高等优点,术后结合咽喉宁等中药口服及局部应用,术后恢复快,复发少,值得临床推广应用.     

喉癌术后复发时间的相关因素及预后分析

目的分析复发性喉鳞状细胞癌患者术后复发时间与其预后的相关性。方法选取2010年6月~2017年3月在我院就诊的41例喉鳞状细胞癌术后复发患者，对相关参数进行单因素和多因素分析，并用Kaplan meier法对预后进行分析。结果41例患者在术后1～120个月内复发。单因素分析显示临床分期、病理分级与复发时间相关（P＜0.05）；多因素分析显示病理分级（P=0.003）是复发时间的独立影响因素，多因素分析显示初次手术方式是复发性喉癌患者预后的独立影响因素。结论病理分级分化程度低以及临床分期晚的患者更加容易早期复发，应加强随访以助于早期发现，且对≤24个月复发的患者采取更加激进的治疗措施；在激光手术早期开展时T2期患者应慎重选择内镜下手术方式，减少患者术后复发，进而提高患者的生存率。     

喉癌患者血清细胞角蛋白片段21-1检测及临床意义

目的 :探讨细胞角蛋白片段 2 1 1(CYFRA2 1 1)在喉癌患者血清中的表达及其临床意义。方法 :采用酶联免疫吸附法对 2 5例喉癌患者手术前后的血清CYFRA2 1 1进行检测 ,并与 2 0例喉良性病变患者进行对比。结果 :喉癌患者血清CYFRA2 1 1阳性率为 6 0 .0 % ,术前CYFRA2 1 1水平为 (5 .14± 1.82 ) μg/L ,显著高于喉良性病变 (2 .17± 0 .6 8) μg/L(P <0 .0 5 )。术后血清CYFRA2 1 1水平显著下降并低于正常水平。术后复发者血清CYFRA2 1 1水平再次上升。CYFRA2 1 1含量与喉癌患者的年龄、性别及肿瘤部位无关 ;高水平血清CYFRA2 1 1与喉癌临床分期、病理分级及淋巴结转移相关 ,分化愈差 ,CYFRA2 1 1含量越高。结论 :血清CYFRA2 1 1可望作为喉癌诊断、预后判定和术后随访有用的生物学指标。     

Management decisions in laryngeal carcinoma in situ

Twenty-one patients with laryngeal carcinoma in situ (n = 12) or carcinoma in situ with microinvasion (n = 9) were treated with laser mucosal dissection of the vocal cords and/or superficial laser cordectomy. The normal architecture of the vocal cords was preserved because the depth of vaporization was usually superficial in these early cases. Five patients had recurrence, new tumor, or persistence of abnormal tissue that required additional laser surgical treatments. With a follow-up range of 6 months to 4 years, all patients currently are free of laryngeal abnormality, and no patient has needed open laryngeal surgery or radiation therapy. Transoral endoscopic laser resection of laryngeal carcinoma in situ with or without microinvasion should be the treatment of choice for these early lesions.     

Stathmin基因在喉鳞状细胞癌中的表达及临床意义

目的 观察stathmin基因和蛋白质在喉鳞状细胞癌(简称鳞癌)中的表达情况,探讨stathmin基因与喉鳞癌生物学行为的关系及临床意义,进一步认识喉鳞癌发生和发展的分子机制.方法选取2005年3月至2006年4月的38例喉鳞癌患者,术中从肿瘤中心部位取癌组织(实验组),在肿瘤边缘外1.0cm部位取癌旁正常组织(对照组).应用半定量逆转录-聚合酶链反应(RT-PCR)分析38例患者的喉鳞癌组织和癌旁正常组织中stathmin基因mRNA的表达水平,冰冻切片免疫组织化学方法检测喉鳞癌组织和癌旁正常组织中stathmin蛋白的表达情况.结果 RT-PCR结果显示,stathmin基因mRNA在38例喉癌患者的喉癌组织和癌旁正常组织均呈阳性表达;经半定量分析,stathmin mRNA在喉癌组织中的表达水平明显高于在癌旁正常组织的表达水平(t=9.655,P＜0.05).免疫组织化学发现,stathmin蛋白在26例(26/38,68.4%)患者的喉癌组织呈阳性表达,在13例(13/38,34.2%)患者的癌旁正常组织呈弱阳性表达;stathmin蛋白在喉癌组织中的阳性表达率明显高于在癌旁正常组织的阳性表达率(x2=8.901,P＜0.05).同时发现,stathmin mRNA的表达水平和stathmin蛋白的阳性表达率在Ⅲ期和Ⅳ期喉癌组明显高于Ⅰ期和Ⅱ期病例组(t=6.284,x2=5.810,P＜0.05),有颈部淋巴转移组明显高于无转移组(t=9.350,x2=6.923,P＜0.05).结论 stathmin基因和蛋白在喉鳞癌中的表达明显高于癌旁正常组织,在中晚期喉鳞癌中的表达明显高于早期喉鳞癌,并且与颈淋巴转移有关.stathmin基因与喉鳞癌的发生和发展均有密切关系,并可能与喉癌的预后有关.     

Salvage surgery after radiotherapy for laryngeal cancer: from endoscopic resections to open-neck partial and total laryngectomies

OBJECTIVE: To evaluate our experience in management of radiotherapy failure using endoscopic resection (ER) with carbon dioxide laser, open-neck partial laryngectomy (ONPL), and total laryngectomy. DESIGN: Retrospective medical record review. SETTING: Referral university hospital. PATIENTS: Seventy-one patients with laryngeal cancer previously treated with radiotherapy (69 patients) and chemoradiotherapy (2 patients) underwent salvage surgery. INTERVENTIONS: The treatment policy encompassed ER for glottic rT1a, rT1b with limited anterior commissure involvement, and rT2 with normal cord mobility carcinoma. All ONPLs were performed for rT1 and rT2 tumors with suboptimal endoscopic exposure, rT2 tumors with impaired cord mobility or transcommissural extension, and rT3 tumors for limited paraglottic space invasion or involvement of the inner portion of the thyroid cartilage. Total laryngectomy was planned in patients who were not suitable for partial laryngectomy owing to poor general condition, for rT3 carcinoma with massive involvement of the paraglottic space, and for rT4a tumors. MAIN OUTCOME MEASURES: Clinical, radiologic, surgical, and pathologic data. Survival curves were calculated using the Kaplan-Meier method. Comparisons between different variables were performed using the log-rank test. RESULTS: Salvage surgery consisted of ER in 22 patients, ONPL in 15, and total laryngectomy in 34. The pT category after salvage surgery was pT1 in 12 patients, pT2 in 20, pT3 in 20, and pT4a in 19. Five-year disease-specific and disease-free survival and laryngeal preservation for the entire series were 72%, 61%, and 40%, respectively. CONCLUSIONS: Survival rates for the entire series were not different from those previously reported using a more aggressive surgical approach without attempts at organ preservation. The laryngeal preservation rate justifies conservative treatment in the presence of limited recurrent lesions.     

早期声门癌的内镜治疗

随着微创技术的不断成熟,早期声门型癌大多采取内镜下手术治疗。自上个世纪70年代CO₂激光引入早期喉癌的治疗以来,因其无颈部及气管切开、术后并发症少、住院时间短、病人恢复快、喉功能保存好等优点,越来越被广泛应用,已被公认为首选的内镜手术方式。就经口CO₂激光治疗早期声带癌的适应证、并发症、局限性、手术分型等内容进行讨论,在综述早期声门癌内镜治疗的历史及发展的同时,特别强调早期声带癌内镜手术中遵循肿瘤外科原则的重要性。     

水通道蛋白1在喉癌组织中的表达及分布

目的：明确水通道蛋白1（AQP1）在喉癌组织中的表达和分布,并探讨其在喉癌发病中可能的作用机制及意义。方法：取喉癌组织20例及癌旁正常组织15例,应用RT-PCR,Western blot,免疫组织化学技术检测AQP1蛋白在喉癌和正常对照组织中的表达及分布。结果：AQP1表达于正常喉黏膜固有层的血管内皮细胞及喉黏膜腺体上。在喉癌组中主要表达于肿瘤的血管内皮细胞,在肿瘤上皮细胞和癌巢中亦有表达。喉癌中AQP1 mRNA及蛋白表达水平较癌旁正常组织增多,二者之间差异有统计学意义。结论：AQP1在喉癌组织中表达增高,在癌旁正常组织中较低,提示AQP1在喉癌发病中的重要作用有待深入研究。     

Surgical treatment of laryngeal tumors with subglottic extension and tracheal tumors with composite nasal septal cartilage graft: technique and outcome

OBJECTIVE: Composite nasal septal cartilage grafts (CNSCG) are effective grafting materials in laryngeal and tracheal reconstruction following tumor resection. METHODS: Between 1985 and 2005, we used CNSCG for the reconstruction of defects following resection of laryngeal tumors with subglottic extension (20 cases), subglottic mesenchymal tumors (2 cases), invasive thyroid carcinoma (4 cases), tracheal tumors (3 cases) and esophagus carcinoma with tracheal invasion (1 case) in total of 30 patients. RESULTS: The patients with subglottic tumors were decanulated within 5-7 days except one case. We achieved satisfactory voice and swallowing without any sign of recurrence. Overall complications consisted of subglottic stenosis in one case, and unilateral paralysis of recurrent laryngeal nerve in two cases. One patient with subglottic laryngeal carcinoma died due to neck and distant metastases 4 years after the operation. All patients are well with a mean follow-up period 9 years. Three patients with tracheal tumors underwent lateral resection and reconstructed with CNSCG. Satisfactory healing of the grafts was seen in all cases without local recurrence or complication with a mean follow-up period of 62 months. One of the patients had distant metastases 3 years after the operation. The patient with esophagus carcinoma and tracheal invasion was treated by total esophagectomy, gastric pull-up, tracheal resection and CNSCG reconstruction. He died at postoperative 5th day due to mediastinitis as a complication of gastric pull-up. CONCLUSION: Free composite cartilage graft is a reliable material in the reconstruction of defects after surgery of laryngeal tumors with subglottic extension, invasive thyroid and esophagus tumors and well-selected tracheal tumors.     

Quality of life after treatment for early laryngeal carcinoma

Radiotherapy and surgery for early laryngeal cancer achieve comparably good results in patient survival, and the choice of treatment between them is being influenced increasingly by the expected voice quality and quality of life (QoL). The superiority of vocal function after radiotherapy has been shown in previous objective voice assessment studies. This study compared the QoL of long-term survivors after endoscopic laser surgery or radiotherapy for early laryngeal carcinoma. QoL was evaluated with two validated questionnaires: the global EORTC QLQ-C30 and the head- and neck-specific EORTC QLQ-H & N35. A total of 62 patients were included. Among 56 patients completing the questionnaires (90% completion rate) 40 were treated by endoscopic CO₂ laser surgery and 16 with radiation therapy. All 56 patients showed a good global QoL with no significant difference between the two treatment modalities. The head- and neck-specific evaluation revealed significantly better scores for surgically treated patients in questions about swallowing of solid food, xerostomia, and tooth problems, but no difference in questions about voice quality. Both treatment modalities achieve good QoL after treatment of early laryngeal tumors. Irradiated patients mainly complain about xerostomia related problems. In contrast to objective measurements long-term survivors after surgery do not rate their voice poorer than irradiated patients. The EORTC questionnaires are validated and useful tools in assessing QoL and should further be used in prospective trials. Received: 7 September 2000 / Accepted: 6 November 2000