环状软骨上喉部分切除术治疗中晚期喉癌的效果

目的：探讨环状软骨上喉部分切除术治疗中晚期喉癌的临床效果。方法：18例声门型癌和5例声门上型癌,包括：T1bN0M03例,T2N0M06例,T3N0M012例,T4N0M02例,分别行环状软骨上喉部分切除术加环舌固定术或环舌会厌固定术进行治疗。结果：3年生存率92.9%（13/14）。术后第10～18天（平均16天）拔气管套管,拔管率100%。术后拔除鼻饲管时间为第7～35天（平均14天）。23例患者均能进行日常言语交流。结论：环状软骨上喉部分切除术加环会厌固定术或环舌会厌固定术可以治疗T1b～T4声门型和声门上型喉癌。该技术在根治肿瘤的同时能使患者保留呼吸、吞咽和部分发音功能,值得推广。     

环状软骨上喉次全切除术治疗喉癌—附56例报告

目的:探讨环状软骨上喉次全切除术治疗喉癌并重建喉功能的疗效。方法:回顾性分析1999年～2010年间行环状软骨上喉次全切除,并行环舌骨固定术或环-舌骨-会厌固定术的喉癌患者56例(声门上型14例,声门型42例的临床资料。其中行环-舌骨-会厌固定术47例,行环-舌骨固定术9例。结果:所有患者术后发音效果较好,并能正常进食。92.8%的患者拔除气管套,3年和5年生存率分别为85.4%和75.0%。结论:环状软骨上喉次全切除术适用于部分声门上型喉癌和大部分声门癌,可以在充分地切净肿瘤的同时,保留喉的功能。     

声门上水平部分喉切除术30例报告

目的　评价喉声门上水平部分切除术在声门上喉癌的应用价值。方法　采用声门上水平部分喉切除术治疗声门上癌 30例 ,在行声门上水平部分切除术同时有 3例舌根部分切除 ,1例一侧犁状窝内侧壁切除 ,舌骨及会厌前间隙均切除 ,用甲状软骨膜与喉室底壁黏膜缝合封闭甲状软骨创面 ,在黏膜下将残喉与舌根紧贴缝合。结果　3、5年生存率分别为 89.5 %和 77.8% ,局部复发率为 3.3% ,颈部淋巴结复发率为 6 .7%。喉功能恢复 (发音功能 )均良好。拔管率为 96 .7% ,吞咽功能术后 2 0～ 6 0天均恢复正常饮食。并发症 :咽瘘 1例 ,伤口感染 1例 ,吸入性肺炎2例 ,发生率 14 .3%。结论　该术式在声门上喉癌 T1 、T2 及累及会厌前间隙及舌根的 T3病变治疗中能彻底切除肿瘤 ,又能保留喉的生理功能 ,是理想的喉切除术     

改良环状软骨上喉部分切除术治疗声门型喉癌的临床价值

目的：总结改良环状软骨上喉部分切除术治疗声门型喉癌的经验,评价该术式对保留喉功能的价值。方法：选取26例声门型喉癌进行改良环状软骨上喉部分切除术,总结其手术方法。结果：1例出现环状软骨脱垂及喉狭窄,3例出现皮下感染,余患者均恢复良好。随访3～5年,2例患者死亡。结论：应用改良环状软骨上喉部分切除术能改善患者的发音质量,缩短吞咽功能恢复时间,提高拔管率,并且不影响生存率。改良环状软骨上喉部分切除术对声门型喉癌有积极的治疗意义。     

声门下区喉癌的临床特点与手术治疗

目的　探讨声门下区喉癌的临床特点和治疗手段。方法　 7例 46～ 74岁 (平均 62 5岁 )原发声门下区喉癌。分期为T2 N0 M0 2例 ,T3 N1M0 3例 ,T3 N0 M0 1例 ,T4 N1M0 1例。对其临床特点、治疗方法、预后等方面进行分析。结果　声门下区癌发病率低 ,气管造口复发率高 ,声门下区癌T3 、T4 病变者宜全喉切除。T1、T2 病变者作声门下区部分切除预后同样好。结论　声门下区癌易向气管旁淋巴结、喉前淋巴结转移。术中应注意这些淋巴结的清扫。术后放疗对肿瘤的复发和转移是一种有效的辅助治疗。     

声门下区喉癌的临床特点与手术治疗

目的 探讨声门下区喉癌的临床特点和治疗手段。方法 7例46-74岁（平均62.5岁）原发声门下区喉癌,分期为T2N0M02例,T3N1M03例,T3N0M01例,T4N1M01例。对其临床特点、治疗方法、预后等方面进行分析。结果 声门下区癌发病率低,气管造口复发率高,声门下区癌T3、T4病变者宜全喉切除。T1、T2病变者作声门下区部分切除预后同样好。结论声门下区癌易向气管旁淋巴结、喉前淋巴结转移。术中应注意这些淋巴结的清扫。术后放疗对肿瘤的复发和转移是一种有效的辅助治疗。     

161例声门上喉癌保留喉功能手术的研究

目的探讨声门上型喉癌保留喉功能手术治疗方法及临床疗效.方法对手术治疗161例声门上型喉癌患者进行临床分析.临床分期按1997年UICC分期标准,其中,Ⅰ期8例,Ⅱ期31例,Ⅲ期77例,Ⅳ期45例.保留喉功能手术方法包括:喉声门上部分切除术;喉声门上水平垂直部分切除术;喉垂直部分切除术;喉环状软骨上部分切除-环舌骨吻合术;person's(黏膜发音管成形)术.修复组织:胸骨舌骨肌瓣;肩胛舌骨肌瓣;颈阔肌肌皮瓣;颈阔肌肌筋膜瓣;双蒂接力肌甲状软骨膜瓣;甲状软骨膜瓣;会厌下移.Kaplan-Meier计算生存率及肿瘤复发趋势.结果全组患者3、5年生存率分别为80.98%和69.11%,Ⅲ、Ⅳ期喉部分切除术患者的3、5年生存率分别为76.63%和64.05%,Ⅲ、Ⅳ期全喉切除术患者的3、5年生存率分别为71.59%和60.58%.Ⅲ、Ⅳ期喉部分切除术与全喉切除术患者的生存率差异无显著性(P=0.5552).喉部分切除术3、5年肿瘤复发率为11.83%和14.08%,全喉切除术肿瘤复发率为12.17%和16.58%,喉部分切除术与全喉切除术患者的肿瘤复发率相比较差异无显著性(P=0.4517).喉部分切除术拔管率为79.07%(101/129).全组喉部分切除术占80.12%(129/161);Ⅲ、Ⅳ期患者中,喉部分切除术占72.95%(89/122).结论声门上喉癌,经认真选择和修复,即使是晚期声门上喉癌,保留其喉功能的手术是可行的,而且生存质量也能明显提高.     

喉声门上水平部分切除术在声门上喉癌治疗中的应用

目的评价喉声门上水平部分切除术对声门上喉癌的治疗作用。方法回顾性分析了１０７例声门上型喉癌行水平部分切除术的治疗结果。男性６９例,女性３８例。年龄在３８～８０岁之间,平均年龄５１．４岁。手术适应证选择包括声门上Ｔ１病变、未累及声带的Ｔ２病变和累及会厌前间隙及梨状窝内壁的Ｔ３病变;舌会厌谷受累的Ｔ４病变同期切除部分舌根。结果术后气管套管拔除率９２．２％。发音满意率为９１．６％。Ｉ、ＩＩ、ＩＩ和ＩＶ期５年生存率分别为１００．０％、８３．３％、７１．７％和４１．７％。结论各期声门上型喉癌经适当选择,可采用声门上水平部分喉切除术,根治率较好而喉功能得以保留。对于颈部Ｎ０患者不应一律行颈淋巴结清除术;上颈淋巴结清除术作为诊断措施,效果肯定,可避免不必要的全颈淋巴结清除术。     

声门型喉癌喉部分切除术98例疗效分析

目的 探讨声门型喉癌不同类型喉部分切除术的治疗效果,方法 回顾性分析98例声门型喉癌喉部分切除术的临床资料,总结不同类型喉部分切除术后喉功能恢复情况。结果 98例患者的总拔管率为94．9％,全部患者均获得不同程度的发音功能,发音中等及良好者83例,占84．7％。出现误咽15例,经吞咽训练均恢复正常进食,4例术后1～2年颈部淋巴结转移．2例会厌喉成形术者喉腔局部复发。术后3年和5年生存率分别为86．5％、81．7％。结论 声门型喉癌喉部分切除术在彻底切除肿瘤的同时尽可能地保全了患者的喉功能,提高了患者的生存质量,3年和5年生存率不低于喉全切除术。     

喉声门上水平部分切除术

1984—1988年间,我们对36例声门上型喉癌患者做保留喉上神经喉声门上水平部分切除术。这是一种保留生理功能的手术,效果满意。报告如下。临床资料36例声门上型喉癌,1例鳞腺癌(占2.78％),35例鳞癌(占97.22％);男21例,女15例,最大年龄70岁,最小年龄42岁。50—60岁居多。癌肿局限于会厌喉面10例(占27.8％),累及室带9例(占25％),累及杓会厌皱襞7例(占19.4％),位于室带2例(占5.6％),位于会厌面侵及舌会厌皱襞4例(占11.1％),位于会厌侵及舌根4例(占11.1％)。     

环状软骨上喉次全切除术发音效果的评价

目的　评价环状软骨上喉次全切除术后患者的发音效果。方法　回顾性分析２０００年１月至２００８年１２月行环上喉部分切除合并环 舌骨固定术或环 舌骨 会厌固定术的７６例住院患者,男性７１例,女性５例,年龄３９～６８岁,平均６１岁。按２００２年ＵＩＣＣ喉癌ＴＮＭ分类,其中声门上型４４例（Ｔ_２Ｎ_０Ｍ_０１８例、Ｔ_２Ｎ_１Ｍ_０１６例、Ｔ３Ｎ_０Ｍ_０６例、Ｔ_３Ｎ_１Ｍ_０４例）,声门型３２例（Ｔ_２Ｎ_０Ｍ_０１１例、Ｔ_２Ｎ_１Ｍ_０１３例、Ｔ_３Ｎ_０Ｍ_０５例、Ｔ_３Ｎ_１Ｍ_０３例）。结果　各型环状软骨上喉部分切除术手术后其声学参数值差异有统计学意义（Ｐ＜０.０５）。ＣＨＥＰ保留双侧杓状软骨振幅微扰值较保留单侧杓状软骨者有显著性差异。Ｊｉｙａｎ分级评分法评估各项指标差异明显。行围手术期言语训练者发音效果优于未行言语训练者。结论　环状软骨上喉部分切除术治疗后,不同类型术后嗓音恢复的质量不尽相同。手术切除的范围、深度对喉结构的恢复及发音功能有影响,患者术后能进行正常的生活交流。     

Conservation laryngeal surgery

Conservation laryngeal surgery is an increasingly available alternative for treatment of laryngeal cancer. In addition to the traditional techniques of vertical partial laryngectomy (hemilaryngectomy) and supraglottic laryngectomy, new techniques are now in practice that extend the indications to a far greater number of patients. The carbon dioxide laser is used to resect both glottic and supraglottic cancers. This procedure is best applied to early stage I and stage II cancers. Reports indicate superior functional outcome to open surgical procedures, with shorter hospital duration, less morbidity, and equivalent survival rates. The supracricoid partial laryngectomy is becoming increasingly popular for intermediate extent tumors. This novel procedure allows resection of transglottic tumors and tumors with vocal cord paralysis while preserving the patient’s speech and swallowing and avoiding a permanent tracheal stoma.     

喉鳞癌全喉与喉部分切除术的远期疗效分析

目的　回顾分析声门上型及声门型喉鳞癌患者经全喉及喉部分切除治疗后的远期效果 ,提出今后治疗措施。方法　 42 3例喉癌患者中 ,声门上型 32 7例 ,声门型 96例。 2 43例全喉切除患者中 ,声门上型喉癌 2 10例 ,声门型 33例。喉部分切除的 180例中 ,声门上型 117例 ,声门型 6 3例。依照直接法计算出声门上型和声门型喉癌的全喉切除与喉部分切除的 1,3,5年生存率 ,以及各期病例的 3,5年生存率。结果　 32 7例声门上型喉癌术后 5年生存率为 72 9% ,全喉与喉部分切除的 5年生存率分别为 70 1%和 77 4% (P >0 0 5 )。 96例声门型喉癌术后 5年生存率为 86 0 % ,其中全喉与喉部分切除后的 5年生存率分别为 72 2 %和 92 3% (P <0 0 5 )。结论　喉癌治疗仍以手术为主 ,声门上型喉癌的喉部分切除与全喉切除远期疗效大致相等 ,而声门型喉癌的喉部分切除远期疗效明显高于全喉切除。在适应证选择合适的基础上 ,应大力倡导开展有利于患者生存质量的喉部分切除手术。     

T3声门型喉鳞状细胞癌手术治疗效果及影响因素分析北大核心

目的:探讨T_(3)声门型喉癌患者行全喉切除术或部分喉切除术的临床效果及影响因素。方法:回顾性分析手术治疗的84例T_(3)声门型喉鳞状细胞癌患者的临床资料,包括性别、年龄、病理学分级、N分期、手术方式、手术切缘、术后放疗、术后咽喉部复发、术后颈部淋巴结复发,评估与喉癌预后的相关性;生存分析采用Kaplan-Meier法计算,单因素分析采用Log-rank检验或者χ^(2)检验,多因素分析采用Cox比例风险回归模型。结果:T_(3)声门型喉癌患者5年总体生存率为75.0%,10年总体生存率为64.7%;部分喉切除术患者5年生存率79.6%,全喉切除术患者5年生存率68.6%;单因素分析显示年龄、病理学分级、手术切缘、N分期、术后咽喉部复发、术后颈部淋巴结复发与T_(3)声门型喉癌的预后相关(P<0.05);多因素分析显示年龄、N分期、手术切缘、肿瘤复发是影响T_(3)声门型喉癌患者生存的独立危险因素(P<0.05)。结论:对于选择的T_(3)声门型喉癌患者,部分喉切除术在保留喉功能的同时可获得较好的肿瘤学效果;精确评估肿瘤范围,保证安全切缘,合理的颈清扫术及术后及时放疗可以提高患者的生存率。     

Comparing treatment outcomes of radiotherapy and surgery in locally advanced carcinoma of the larynx: a comparison limited to patients eligible for surgery

PURPOSE: The use of radical radiotherapy and surgery for salvage (RRSS) in locally advanced squamous cell carcinoma (SCC) of the larynx is controversial. In the absence of randomized studies, it is unclear if RRSS can match the rates of locoregional control and survival reported for primary surgery in this setting. The aim of this study was to compare treatment outcomes of radiotherapy and surgery in comparable patients with CS III-IV SCC of the larynx. METHODS AND MATERIALS: Eighty-two patients with untreated T2N+M0 or T3T4NM0 SCC of the larynx were treated with a policy RRSS at the Toronto-Sunnybrook Regional Cancer Centre between June 1980 and December 1990. The medical records at presentation were reviewed independently by a panel of three surgical oncologists blinded as to treatment outcome to determine patient suitability for laryngectomy and neck dissection using eligibility criteria adopted by recent clinical trials. Treatment outcomes for surgery-eligible patients were compared to results of comparably staged patients in the surgical literature since 1980. RESULTS: Sixty-three patients (77%) were eligible for study. With a median follow-up of 3 years, radiotherapy controlled the primary in 8/20 evaluable glottic primaries and 21/41 evaluable supraglottic primaries. Forty-five percent of patients surviving 5 years retained a functional larynx. Sixteen of 29 relapsing patients were salvaged with surgery. Disease above the clavicles was controlled in 65% of T3T4N0N+ glottic primaries (compared to a published range of 53% to 79%) and 82% of T3N0 glottic primaries (compared to a published range of 69% to 84%). The 5-year overall survival of patients with T3T4 glottic cancer was 54% compared to a published range of 50% to 63%. The cause-specific survival (CSS) of patients with T3N0 glottic primaries (86% at 1 year and 73% at 2 years) was identical to the only published report of CSS in the surgical literature. CONCLUSION: A policy of RRSS offers a good chance of laryngeal conservation without compromising ultimate locoregional control or survival when compared to primary laryngectomy and neck dissection in patients with locally advanced carcinoma of the larynx meeting the surgical eligibility of clinical trials.     

Laryngeal carcinoma in patients 40 years of age and younger

Between 1950 and 1985, 570 patients with squamous cell carcinoma of the larynx were diagnosed and treated in the Otolaryngology Department of the Beilinson Medical Center. Of these, 20 patients (2.8%) were aged 40 years or younger. Twelve patients (60%) had glottic carcinoma in Stage I (T1N0M0) when initially diagnosed, one patient had supraglottic carcinoma in Stage I (T1N0M0) and seven patients (35%) had laryngeal carcinoma in Stage II (T2N0M0) and III (T3N0M0). Patients with T1N0M0 received only radiotherapy. Three patients with T2N0M0 underwent total laryngectomy and also received postoperative radiotherapy. Four patients with the tumor in T3N0M0 received pre-operative and postoperative radiotherapy in addition to total laryngectomy. The 5-year survival rate for T1N0M0 and T2N0M0 was 100% and for T3N0M0 66%. Although a high percentage of the young patients presented for treatment with advanced disease, the survival rate compared the same or favorably with rates in older patients. This supports the concept of aggressive treatment when there is a recurrence or second primary, particularly because it is well tolerated in the young age group who do not exhibit many of the conventional risk factors and therefore, have a better prognosis.     

Supracricoid laryngectomy with Cricohyoidopexy--a clinico oncological & functional experience

Supracricoid laryngectomy with Cricohyoidopexy (CHP) is a procedure that is commonly practiced in France & Canada. Eight such procedures were carried out at Kidwai Memorial Institute of Oncology, Bangalore during the period from 1991 through 1996. Four Glottic, 3 transglottic & one supraglottic cancers were subjected to this procedure. The study comprised of 7 males & 1 female. The average age was 52 years. Two procedures were done as salvage procedures for radiotherapy (RT) failures. The patients have a follow-up ranging from one year to six years, except for one who died soon after discharge from hospital secondary to myocardial infarction. Median follow up was four years. The three year acturial disease free survival was 83%. Six out of 8 (75%) were decannulated, and physiologic deglutition without aspiration was established in all patients. Hospital stay ranged from 11 to 62 days averaging 29 days. The speech was analyzed together with other partial laryngectomies and was found to be qualitatively worse than speech after other partial laryngectomy procedures. In addition speech intensity levels after CHP were lower than in other partial laryngectomy procedures. The speech however allowed normal social interaction. This procedure certainly has distinct oncological advantage in encompassing circumferential horse-shoe lesions with minimal subglottic extension which in the past would have received total laryngectomy and needs to be included in the repertoire of speech restorative surgery in laryngeal cancers.     

Recurrences after irradiation in early vocal cord cancer with literature review

Radiation therapy in early glottic cancer offers an excellent cure rate with preservation of voice. This study is an analysis of 25 (18%) patients who had failures after irradiation. Ten patients were in stage I (T1N0M0) and 15 patients in stage II (T2N0M0). All patients received megavoltage irradiation with an average dose of 6600 rad, 180 to 200 rad per day, 5 days in a week. Of the failures, 15 patients had the tumor controlled by salvage surgery, laryngectomy being the most common surgical procedure. The median time to recurrence was 23 months. A detailed analysis of the failures, along with a literature review, is done in this paper.     

不同手术方案的喉癌患者喉环状软骨上部分切除术后发生误咽的比较

目的 比较采用不同手术方案治疗的喉癌患者喉环状软骨上部分切除术后误咽发生情况及其程度.方法 回顾性分析67例喉癌患者行喉环状软骨上部分切除术后误咽的发生情况,其中行喉环状软骨上部分切除环舌骨会厌吻合术(SCPL-CHEP)37例,喉环状软骨上部分切除环舌骨吻合术(SCPL-CHP)30例,并采用自制的量化的术后误咽程度评分表对术后5～20 d患者进行误咽程度评估.结果 SCPL-CHEP组术后误咽程度评分为(2.71±0.31)分,SCPL-CHP组为(3.43±0.64)分,两组术后误咽程度评分差异有统计学意义(P<0.001).Pearson相关分析显示,年龄是喉环状软骨上部分切除患者出现术后误咽的一个重要因素,SCPL-CHEP组术后误咽程度评分与患者年龄的相关系数为0.947(P<0.0001),SCPL-CHP组为0.907(P<0.0001).SCPL-CHEP组和SCPL-CHP组术后8周误咽发生率分别为2.7%(1/37)和23.3%(7/30),两组差异有统计学意义(P=0.012).结论 不同手术方案是喉环状软骨上部分切除患者出现术后误咽的一个重要因素,其中SCPL-CHP后患者误咽发生程度严重,且术后误咽的严重程度随着患者年龄的增加而明显加重,对高龄(>70岁)喉癌患者手术方式的选择应谨慎,特别是SCPL-CHP术式.

Abstract：

Objective To Evaluate the incidence rates and extents of deglutition disorder in patients with laryngeal carcinoma after different types of supracricoid partial laryngectomy.Methods Retrospective analysis of postoperative deglutition disorder in patients with laryngeal carcinoma after different types of supracricoid partial laryngectomy treated in our department from 2005 to 2009.The extents of postoperative deglutition disorder were evaluated using a homemade quantitative score table at 5-20 days postoperation.Results The score of deglutition disorder was 2.71 ± 0.31 in the supracricoid partial laryngectomycricohyoidoepiglottopexy ( SCPL-CHEP ) operation group and 3.43 ± 0.64 in the supracricoid partial laryngectomy-cricohyoidopexy (SCPL-CHP) group, respectively.The deference was statistically significant between the two groups ( P < 0.001 ).The coefficient between age and score of postoperative deglutition disorder was assessed by Pearson correlation analysis.The coefficient of correlation was 0.947 (P < 0.0001 )in the SCPL-CHEP group and 0.907( P <0.0001 ) in the SCPL-CHP group.The incidence rate of deglutition disorder was 1/37 in the SCPL-CHEP group and 7/30 in the SCPL-CHP group, evaluated at 8 weeks postoperation (P = 0.012).The deference between the two groups was significant.Conclusions The type of operation procedure is an important factor affecting the occurrence of postoperative deglutition disorder in the patients after supracricoid partial laryngectomy, more serious in the SCPL-CHP group.The severity of postoperative deglutition disorder is more serious along with the increase of patient's age.For the elderly ( >70 years of age) patients with laryngeal carcinoma, the choice of surgical procedure should be more cautious, especially with the SCPL-CHP operation.