早期声门癌的手术治疗:以室带成形声带

目的:探讨早期声门癌手术切除后的成形方法及治疗效果.方法:1989至1996 年治疗声门癌23例,T1a15例、T1b8例,均为N0M0,T1b者术后配合放疗40～48Gy.方法是切除声带肿物,剥离室带,纵行剖开,下移成形声带并消灭创面.结果:随诊5年以上9例,3～5年8例,1～3年6例,其中2例分别于术后8个月和1年局部复发行全喉切除术,至今患者生存.结论:喉室是声门癌向室带浸润的屏障,喉室深6～8mm,纵行剖开室带,适于成形声带并消除创面,以室带成形声带不影响治疗效果,且发声功能好,3～5年的生存率高于放射治疗.     

Our experience in the surgical treatment of T1 carcinoma of the vocal cord

From 1971 to 1986, 94 patients suffering from T1 glottic carcinoma underwent cordectomy at the University ENT Clinic of Thessaloniki, Greece. There were five female and 89 male patients with a median age of 61.7 years. Two year survival rate was 93.7 per cent; five year survival rate was 93.2 per cent. Seventeen of the patients suffered recurrence, but 11 of them after laryngectomy or radiotherapy are alive with no sign of the disease. Tracheostomy was not performed in the majority of our cases. The relationship between the site of recurrence and survival as well as the role of radiotherapy before and after cordectomy in some of our patients are discussed. We believe that despite the good results of radiotherapy in T1 carcinoma of the vocal cord and the introduction of other treatment modalities such as CO2 laser, cordectomy by laryngofissure is still of value with very good survival results and minimal discomfort for the patient.     

A simple procedure for surgical repair of vocal cord synechia

Summary With a simple method performed since 1962 on six patients for the correction of anterior vocal cord synechia, a paladon granule reinforced with a thread is brought into the larynx from outside after severance of the synechia. With convalescent treatment of the cartilaginous frame, it lies in the anterior commissure for 6 weeks. After endoscopie removal, free glottis and good voice. Tracheotomy is not necessary.     

A simple procedure for surgical repair of vocal cord synechia

With a simple method performed since 1962 on six patients for the correction of anterior vocal cord synechia, a paladon granule reinforced with a thread is brought into the larynx from outside after severance of the synechia. With convalescent treatment of the cartilaginous frame, it lies in the anterior commissure for 6 weeks. After endoscopic removal, free glottis and good voice. Tracheotomy is not necessary.     

支撑喉镜和电子喉镜下治疗声带息肉的对比分析

目的比较支撑喉镜下喉显微外科手术（支撑喉镜组）与电子喉镜下声带息肉摘除术（电子喉镜组）治疗不同类型声带息肉的疗效。方法153例声带息肉患者,其中支撑喉镜组89例,电子喉镜组64例,治疗后1周～13个月复查电子喉镜了解声带恢复情况。结果42侧带蒂声带息肉治愈率,支撑喉镜组（78.6%）和电子喉镜组（82.1%）两组差异无显著性;38侧广基声带声带息肉治愈率,支撑喉镜组（81.3%）明显高于电子喉镜组（52.6%）。结论对于较大的广基声带息肉,首选支撑喉镜下喉显微外科手术;对于小的带蒂声带息肉,由于电子喉镜疗效确切并且方便,可作为首选方案。     

2种不同方式的声带囊肿手术比较

目的:比较声带囊肿电子喉镜下切除和支撑喉镜下显微切除的疗效.方法:电子喉镜及频闪喉镜确诊为声带囊肿的患者92例,随机分为电子喉镜手术组48例及支撑喉镜手术组44例,术前及术后1周、3个月及6个月行电子喉镜检查及嗓音测试.结果:支撑喉镜手术组1例声门暴露不佳,改为电子喉镜下手术.其余均一次性完成手术.电子喉镜组和支撑喉镜组3个月内复发的病例分别是2例和1例,经X2检验,差异无统计学意义(P＞0.05).2组术前及术后1周、3个月及6个月嗓音声学测试经t检验均差异无统计学意义(均P＞0.05).结论:电子喉镜下声带囊肿切除具有视野清晰,操作准确,创伤小,兼有对喉部病变放大作用,能达到支撑喉镜下声带囊肿显微手术相同疗效,电子喉镜还能完成支撑喉镜下无法进行的声带囊肿手术.     

Prognostic significance of histologic grading in vocal cord carcinoma

Long term results show that the behaviour of vocal cord cancer of the same size and undergoing the same therapy may vary widely. The biological behaviour of the tumour was assessed by well defined histopathological criteria of the malignancy evaluated by subserial sections on 49 previously untreated vocal cord carcinomas pT2-T4. Two parameters were related to the tumour cell population: differentiation and polymorphism, as well as the structure and margins of the tumour. Two parameters were related to the tumour-host relationship: vascular and perineural invasion and the cellular response of the host. Each parameter was given a three point score. The resulting malignancy index (total score = 10) gave a significant prediction of prognosis: patients with or without metastasis can be separated, high risk patients can be recognised early and decisions regarding treatment and follow up may be planned.     

Endoscopic vocal cord medialization: A new surgical technique without neck incision for laryngeal palsy

Different types of surgery have been reported for glottal insufficiency due to unilateral vocal cord paralysis. We recently developed a new surgical technique of fascia implantation known as vocal cord medialization. This new method achieves a wide glottal gap during phonation, without the use of an external approach. This new technique is described in detail herein, together with the satisfactory results we obtained in six cases of unilateral vocal cord paralysis with a wide glottal gap during phonation. We recommend this technique in cases of unilateral vocal cord paralysis in which both a satisfactory clinical result and an aesthetically pleasing cosmetic result are required.     

表面麻醉支撑喉镜喉显微手术治疗声带良性病变

目的:探讨喉显微手术治疗声带良性病变的效果及麻醉选择。方法:手术在1%丁卡因表面麻醉支撑喉镜下进行,采用普通手术显微镜连接300mm焦距镜头观察病变。结果:872例中声带息肉353例,声带小结438例,声带囊肿81例,851例完成手术,697例1次治愈,总有效率为96.9%。结论:青、壮年患者,无明显心血管疾病,可选择表面麻醉手术,表面麻醉并发症少,恢复快,支撑喉镜下显微手术清除病变彻底。     

声带癌前病变及癌变动态喉镜追踪观察

目的　探讨动态喉镜下声带癌前病变的表现及其在癌变追踪中的观察价值。方法　用动态喉镜检测声带癌前病变 5 2例 ,观察静态图像及动态图像中粘膜波及振幅的改变 ,并追踪观察癌变 1～ 5 5年。结果　声带癌前病变 5 2例中粘膜波消失或减弱占 86 3% (45 / 5 2 ) ,振幅减弱占 9 6 %(4/ 5 2 )。发现癌变 (声门癌 )T114例 ,粘膜波消失 10 0 %、振幅消失或减弱 10 0 %。结论　动态喉镜可用于声带癌前病变与早期声门癌的鉴别诊断 ,并作为癌变追踪观察的一种简便监测手段。     

两种手术方法治疗双侧声带神经麻痹

目的 通过观察经喉外进路及经支撑喉镜下行CO2激光手术切除杓状软骨治疗双侧声带神经麻痹的疗效,对比两种手术方法的优缺点,择优选取合适的术式。方法 对双侧喉返神经致喉狭窄的13例术后患者进行随访,其中7例行喉外进路杓状软骨切除术声带外展固定,6例行经支撑喉镜下行CO2激光手术切除杓状软骨,13例术前均已行气管切开,术后随访6个月至2年。结果 采用喉外进路杓状软骨切除术声带外展固定7例,术后1次拔管3例,2次拔管2例;采用经支撑喉镜下行CO2激光手术切除杓状软骨6例,术后1次拔管4例,2次拔管1例。结论 两种手术方法各有优缺点。     

伴有声带运动障碍的下咽癌手术

目的 探讨手术治疗伴有声带运动障碍下咽癌患者喉功能保留的可能性.方法 回顾性分析手术治疗伴有声带运动障碍的下咽癌26例患者的临床资料,其中梨状窝内侧壁癌23例,前壁癌2例,环后癌1例;T220例,T3 4例,T42例.全部患者均行梨状窝切除+喉部分切除术,切缘术中冰冻病理检查.残留下咽黏膜缝合修复5例,会厌复合组织瓣转移修复21例,术后均给予放射治疗.结果 全部患者3、5年生存率分别为61.4%、50.8%,喉功能全部恢复者(发音、呼吸及存咽保护功能)20例(76.9%),喉功能部分恢复者(发音及吞咽保护功能)6例(23.1%).结论 对伴有声带运动障碍的下咽癌患者,经过选择可行保留喉功能手术,以提高患者的生活质量.

Abstract：

Objective To explore the feasibility of laryngeal function preservation in surgical treatment of hypopharyngeal carcinoma with restrained vocal cord motility. Methods Twenty-six cases of hypopharyngeal carcinoma with restrained vocal cord motility treated with conservative hypopharyngectomy were retrospectively analyzed. Partial resection of pyriform sinus and partial laryngectomy were performed.The hypopharyngeal wounds were repaired by remaining hypopharyngeal mucosa in 5 cases and by epiglottis complex flaps in 21 cases. All patients received postoperative radiotherapies. Results The overall 3- and 5-year survival rates were 61.4% and 50. 8% respectively. Laryngeal functions ( voice, respiration and deglutition) were completely restored in 20 cases (76. 9% ) and partial laryngeal functions (voice and deglutition) were restored in 6 cases (23. 1% ). Conclusions To improve the postoperative life quality of the patients, the preservative surgery is feasible for some selected cases of hypopharyngeal carcinoma with restrained vocal cord motility.     

A questionnaire using vocal symptoms in quality control of phonosurgery: vocal surgical questionnaire

Background

Quality control after phonosurgery is important and may be time consuming. Often questionnaires focusing on quality of life are applied. We aimed at investigating the use of organ specific symptoms, such as hoarseness and voice failure with the use of self-reported visual analogue scales (VAS) and Likert-scales.

Methods

A vocal surgical questionnaire using VAS and Likert-scales for hoarseness, voice failure and factors that could influence voice quality was given twice consecutively to a group of healthy volunteers (n?=?57, 45 female) and a group of voice patients (n?=?34, 21 females) for a test/re-test study. Secondly, a group of patients undergoing surgery (n?=?90, 61females) answered the questionnaire preoperatively and postoperatively. The difference between test/retest, healthy volunteers and patients, and between pre- and postoperative results were compared.

Results

There was no significant difference in the test/retest results in healthy volunteers nor in the patient group. There was statistically significant difference between the healthy volunteers and patients, and between the preoperative and postoperative results after phonosurgery.

Conclusion

This short and organ specific questionnaire clearly demonstrates the effect of phonosurgery, making it an easy and relevant tool in quality control and potentially reducing the need of postoperative controls in the outpatient clinic.