喉部分切除喉功能重建术

目的探讨喉部分切除术治疗声门型、声门上型喉癌的疗效和功能恢复。方法对我院1992年7月--2003年8月间喉癌行喉部分切除喉功能重建术的32例（占同期喉癌手术59．2％）临床资料进行总结和随访。其中声门型喉癌23例，声门上型喉癌9例；行喉裂开声带切除术室带下移修复术5例，垂直喉部分切除带状肌修复14例。垂直喉部分切除会厌修复3例，扩大垂直喉部分切除环舌根会厌吻合术1例，声门上水平部分喉切除术7例，扩大声门上水平部分喉切除术舌根修复2例。结果1、3、5年生存率分别为96．9％（31／32）、87．0％（20／23）、72．2（13118）。总拔管率为90．6（29／32）。全部病例恢复经口进食，一经拔管均能发音。术后复发率为12．5％。结论喉部分切除术不仅是喉癌根治的有效术式，而且同时可以较好地保留喉的生理功能，提高患者术后的生活质量。     

老龄喉癌喉部分切除术远期疗效观察

目的 探讨老龄喉癌患者行保留喉功能切除术的远期疗效。方法 总结１９８６￣１９９６年间９９例６５岁以上老龄喉癌患者行各种喉部分切降术的临床资料,其中声带切除４４例、垂直半喉切除３１例、声门上水平半喉切除１５例、声门水平切除２例、水平垂直（３／４）切除２２例、喉近全切除５例、喉全切除环咽吻合１０例。结果 术后全部病例均恢复了发音功能及吞咽功能,拔管率为９１．９％。术中无死亡,术后无严重并发症。３、５年     

喉部分切除术81例的疗效分析

目的探讨喉部分切除术的疗效及修复方法。方法回顾分析1980至1999年施行喉部分切除术81例的临床资料,其中声门上型喉癌22例、声门型喉癌59例。结果声门上型喉癌3、5年生存率分别为66.7%、63.2%,声门型喉癌3、5年生存率分别为87.2%、80.5%。拔管率声门上型喉癌为77.2%(17/22),声门型喉癌为93.2%(55/59)。结论喉部分切除术能保留大部分患者喉的呼吸及发声功能,是根治喉癌的有效术式。     

喉癌喉部分切除术的扩展：Ⅱ.声门型喉癌——扩大喉垂直部分切除术

声门型喉癌T3病变的常规治疗为喉全切除术，使病人丧失语言功能。本文报道50例喉癌声门型T3病变，用扩大垂直喉部分切除术来治疗，修复主要用舌骨肌瓣。3、5年生存率为76.7%、73.0%。除管率87.2%，语音近乎正常者87.5%。全部恢复经口进食。喉癌声门型T3病例，对侧声及杓状软骨完好者应考虑喉扩大垂直部分切除术，即常规喉垂直部分切除加杓状软骨切除，必要时环状软骨部分切除，以扩大喉后下切缘，用以根治肿瘤，保存喉功能。     

喉癌部分喉切除术

目的探讨喉癌部分喉切除术的方法.方法总结59例喉癌部分喉切除经验.其中喉裂开声带切除2例;垂直喉部分切除38例;水平喉部分切除10例;次全喉切除加同侧颈廓清术2例;水平喉部分切除加同侧颈廓清7例.结果本组病例的3年生存率为83.8%,5年生存率为68.2%;59例中56例顺利拔管;全部病人术后发音清晰,吞咽正常.结论声门癌与声门上癌(T1～T2)病人行部分喉切除是更佳选择.     

老龄喉癌喉部分切除术远期疗效观察

目的探讨老龄喉癌患者行保留喉功能切除手术的远期疗效。方法总结１９８６～１９９６年间９９例６５岁以上老龄喉癌患者行各种喉部分切除术的临床资料,其中声带切除１４例、垂直半喉切除３１例、声门上水平半喉切除１５例、声门水平切除２例、水平垂直（３／４）切除２２例、喉近全切除５例、喉全切除环咽吻合１０例。结果术后全部病例均恢复了发音功能及吞咽功能,拔管率为９１．９％。术中无死亡,术后无严重并发症。３、５年生存率分别为７６．７％、７５．５％。结论老龄不是保留喉功能手术的禁忌证,关键是正确掌握各种术式的适应症及提高外科手术技巧减少术后并发症。     

保留功能的喉癌手术70例报告

目的 :探讨喉部分切除术治疗声门型、声门上型喉癌的远期疗效和功能恢复。方法 :对 1978年 7月～1998年 8月间手术的 70例临床资料进行总结和随访。其中声门型喉癌 6 0例、声门上型喉癌 10例 ;施行喉裂开声带切除术 2 2例 ,垂直半喉切除术 2 2例 ,Majer- Piquet手术 17例 ,水平半喉切除术 7例 ,Arslan手术 2例。结果 :1、3及 5年生存率分别为 98.5 3%、87.0 4%和 78.2 6 %。拔管率为 10 0 %。全部病例恢复经口进食 ,一经拔管均能发音。并发症发生率和术后复发率各为 15 .71%和 13.0 4%。结论 :喉部分切除术是功能保全性喉部恶性肿瘤根治的有效术式。它在切除肿瘤、延长生命的同时可以较好地保留喉的生理功能 ,提高患者术后的生活质量     

声门型喉癌垂直喉部分切除术后修复方法探讨

目的 :研究声门型喉癌垂直部分喉切除术后修复方法。方法 :回顾性分析 5 8例声门癌行垂直或扩大垂直部分喉切除术的临床资料 ,总结各种修复术后喉功能恢复情况。结果 :术后 3、5年生存率分别为 87.2 %和80 .5 % ,总拔管率 93.1% ,全部患者均获得不同程度的发音功能 ;误吸 3例 ,全部恢复经口进食。结论 :声门型喉癌术后修复方法主要根据患者病变切除范围而定 ,对于病变切除小者选用带状肌瓣修复最理想 ,对于切除范围大者 ,则用鼻中隔软骨作支架 ;若为次全喉切除 ,则选用 Tucker术式。     

声门型喉癌T_3病变喉部分切除术后疗效评价

目的　探讨喉部分切除术对声门型喉癌T3 病变的可行性及修复材料的选择。方法　对 1986年 1月～ 1994年 1月 78例行喉部分切除术的声门型喉癌T3 病变患者的术式及修复方法进行了回顾性分析。结果　患者 3年、5年生存率分别为 88 5 %、75 6 % ,局部复发率 15 4%。应用了梨状窝粘膜 甲状软骨板外侧软骨膜、会厌软骨瓣及带状肌双肌双蒂瓣 3种方法修复创面 ,均获得了较好的喉功能恢复。结论　喉部分切除术是根治声门型喉癌T3 病变合理、有效的方式 ,但不能完全替代全喉切除术 ,应根据切除范围选择合理的修复方式。     

喉垂直部分切除术36例疗效观察

目的探讨喉垂直部分切除术治疗喉癌的临床疗效。方法对2002年1月-2010年6月收治的36例声门型喉癌及跨声门型喉癌行喉垂直部分切除术患者的临床资料进行回顾性分析,其中声门型30例,跨声门型6例。26例行喉垂直部分切除术,10例行喉扩大垂直部分切除术。8例同时行功能性颈廓清术,20例行择区颈廓清术,8例探查患侧Ⅱ、Ⅲ区淋巴结未予颈廓清术。8例（T2N1M0,T3N1M0）声门型喉癌术后6周联合放疗。结果随访满3年患者31例,死亡2例,失访5例;随访满5年患者28例,死亡3例,失访6例。3年生存率80.55%,5年生存率69.44%。结论喉垂直部分切除术是临床上治疗声门型喉癌的有效术式,但需要严格把握适应证。     

Partial laryngectomy with imbrication laryngoplasty for unilateral glottic carcinoma

Treatment options for unilateral glottic carcinoma include radiation therapy, partial laryngectomy, and endoscopic cordectomy. We use partial laryngectomy with imbrication laryngoplasty (PLIL) as a single modality curative approach in a selected group of patients with unilateral glottic carcinoma. PLIL includes a composite resection of the entire vocal fold with its ligament, muscle, adjacent paraglottic tissues, and the adjacent block of thyroid cartilage. A neocord is reconstructed by imbricating the remaining thyroid cartilage strips and covering them with a false vocal fold flap. PLIL provides a rapid recovery of oral/nasal airway and swallowing, excellent voice quality, and a disease-control rate similar or better than other treatment modalities.     

嗓音显微手术治疗早期声门癌的远期疗效观察

目的观察应用嗓音显微手术治疗早期声门癌的远期疗效.方法1989-1997年采用嗓音显微外科技术对44例声带早期癌（T1a）进行了手术治疗.声带早期癌按病变的侵袭深度分为：原位癌（5例）、低侵袭癌（33例）和侵袭癌（6例）.原位癌和低侵袭癌采用微瓣切除技术;对侵袭癌则采取激光切除声带,切缘经过微波或激光处理的方法.每例患者均进行术前、术中和术后录像,术后常规病理送检,并进行长期随访.随访最长时间为11年,最短时间5年.结果应用微瓣切除方法的38例原位癌和低侵袭癌中有6例在手术后随访的2～3年内发现局部复发,局部复发率为15.8%.6例复发患者再次行微瓣切除,其中1例在10年内经历3次微瓣切除手术.1例失随访后1年再次因肿瘤复发就诊,后改喉全切除手术.微瓣切除术病例失访4例,其余随访5年以上均存活,5年生存率为89.5%（失访以死亡计）.应用声带切除术的6例早期侵袭癌中2例于术后2个月发现肿瘤复发而行喉切除术,1例失随访后3年复发改喉全切除术,1例梭型细胞癌术后采用局部放射治疗.声带切除术局部复发率为4/6;3例在3年内死亡,1例3年后失访,2例存活5年以上.结论对病变局限的早期癌,嗓音显微手术不仅能有效地治愈疾病,同时能保护和维持正常的发声功能.对于病变局限在黏膜表面的声带早期癌,嗓音显微手术的微瓣技术不仅是有效的微创治疗措施,同时微瓣切除的病变标本经连续切片的病理诊断也成为了早期声带癌诊断及鉴别诊断的“金标准”.     

Early-stage glottic cancer: oncological results and margins in laser cordectomy

OBJECTIVES: To assess local control of early-stage glottic cancer by laser cordectomy in comparison with previously published external partial laryngectomy series and to determine the relevance of histological margins in glottic cancers excised with laser cordectomy. DESIGN: Retrospective review of laser cordectomy for carcinoma in situ (Tis) and stage T1 glottic cancer from January 1991 to January 2004. SETTING: University hospital. PATIENTS: Fifty-two patients with Tis or T1 glottic cancer. INTERVENTION: Endoscopic laser cordectomy, classified using the system proposed by the European Laryngeal Society Working Committee. MAIN OUTCOME MEASURES: Local control after initial surgery and after salvage compared with a published historical control group, according to the type of cordectomy performed and the histological margins of the removed specimen. RESULTS: Sixteen patients with Tis, 30 with T1a tumors, and 6 with T1b tumors were followed up for an average of 38 months. Type I cordectomy was the most common procedure used to treat Tis, and type II and type III were the most common for treating T1a and T1b tumors. Of 6 recurrences, 4 were treated with laser cordectomy and 2 were treated with external partial laryngectomy. The rate of laryngeal preservation was 100%. There were 3 recurrences despite histologically clear margins. Three (17%) of 18 patients with suspicious margins developed recurrences. The rate of local control with single intervention (46 [89%] of 52) was lower than with partial external laryngectomy. However, 46 (89%) of 52 patients ultimately had less tissue removed by laser than would have been removed by external partial laryngectomy. CONCLUSIONS: Laser cordectomy provides excellent local control and laryngeal preservation. Close follow-up of patients with positive or suspicious margins is an alternative to further routine treatment.     

老龄喉癌患者手术治疗远期疗效分析

目的：探讨老龄喉癌患者手术疗效及预后因素。方法：≥65岁的喉癌患者110例中,行喉部分切除术62例,喉全切除环咽吻合术（Arslan术）8例,喉全切除术40例。53例联合放疗及化疗。结果：4例失访,5、10年生存率分别为66.6%和44.2%;5、10年无瘤生存率分别为57.0%和38.4%,中位生存期84个月。拔管率87.1%。单因素分析组织学分级、治疗模式、淋巴结转移、原发部位不同组间生存分布的差异具有统计学意义（P〈0.01）;肿瘤分期、手术方式、复发、性别不同组间生存分布的差异具有统计学意义（P〈0.05）。多因素分析组织学分级及治疗模式对本组患者生存率影响较大,分化程度低及综合治疗者生存期短。结论：喉功能保全性手术是治疗老龄喉癌患者的有效方法;综合治疗者预后差,不适用于切缘阴性者。     

喉声门型癌声门下受侵与外科治疗选择

目的探讨喉声门型癌声门下受侵合适的外科治疗方式。方法回顾性分析102例喉声门型癌声门下受侵患者的局部声门下受侵范围及所行手术方式。根据受侵范围,将患者分为两组。第一组为声门下受侵在声带游离缘下0.5cm～1.0cm之间,第二组为声门下受侵达声带游离缘下1.0cm以上。分析比较两组患者的不同手术方式的3年无瘤生存率及淋巴结转移率。结果102例喉声门型癌声门下受侵患者总的3年无瘤生存率为58.8%。两组的生存率分别为66.7%(22/33)、55.1%(38/69)。第一组病例喉全切除术、喉近全切除术、喉部分切除术的生存率分别为60.0%(6/10)、2/2、66.7%(14/21);第二组病例喉全切除术、喉近全切除术、喉部分切除术的生存率分别为58.7%(27/46)、50.0%(6/12)、45.5%(5/11)。本资料两组患者的淋巴结阳性率分别为6.1%(2/33)、15.9%(11/69)。淋巴结阳性与阴性患者的生存率分别为23.1%(3/13)、64.0%(57/89)。结论声门下受侵是影响喉声门型癌预后的一个较为重要因素。喉声门型癌声门下受侵患者,声门下受侵范围未超过声带游离缘下1.0cm,如无其它禁忌证,应行喉部分切除术;声门下受侵范围超过声带游离缘下1.0cm,应考虑行喉全切除术。淋巴结转移是影响声门下受侵喉声门型癌的重要因素,随着声门下受侵范围的增大,淋巴结转移率也随之增高。     

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.     

胸骨舌骨肌瓣在垂直喉部分切除声带重建中的应用

目的评价胸骨舌骨肌瓣在垂直喉部分切除声带重建中的应用效果.方法21例声门癌患者,行垂直喉部分切除术,并应用单蒂胸骨舌骨肌瓣行声带重建.结果21例患者术后均发声质量较好,喉功能得到较好的保留.结论垂直喉部分切除术后应用单蒂胸骨舌骨肌瓣行声带重建,术后发声质量良好.     

The treatment of T3 glottic carcinoma with vertical partial laryngectomy

Total laryngectomy has traditionally been considered the optimal treatment for patients with advanced glottic carcinoma who present with a fixed true vocal cord. However, using whole-organ sectioning techniques, it has been demonstrated that vertical partial laryngectomy is a sound oncologic procedure for selected fixed vocal cord lesions. During the period 1969 to 1984, 27 patients who presented at UCLA with T3 glottic carcinoma were treated using vertical partial laryngectomy. Follow-up for these patients averaged 4.0 years. The absolute two-year disease-free survival rate for this group was 85% (23 of 27 patients), and the local cancer recurrence rate during a two-year postoperative interval was 11% (three of 27 patients). These encouraging results support the continued use of partial laryngeal surgery for a subgroup of patients with T3 glottic cancer. Successful patient selection requires a careful analysis of disease extent based on data obtained from physical examination, magnetic resonance imaging or computed tomographic scanning, and direct laryngoscopy.     

喉软骨开窗式喉部分切除术治疗T2-3声门型喉癌

目的 探讨喉软骨开窗式喉部分切除术治疗12-3声门型喉癌的手术效果及其价值.方法 2000年10月至2006年12月采用喉软骨开窗式喉部分切除并同时行喉结构及其功能重建术治疗经适当选择的48例T2-3声门型喉癌,其中男29例,女19例;年龄43～78岁,中位年龄57.0岁.在术前及术后6个月作声嘶程度的听觉心理评价,观察双侧声带的活动度、对称性、平静呼吸时声门宽度和发声时声门闭合程度,评价呼吸和吞咽功能情况;随访肿瘤的复发、转移情况以及患者的生存时间.结果 全部患者顺利拔管,切口均甲级愈合,无手术并发症.患者术后6个月时与术前相比,除声带的活动度外(P=0.343),声嘶程度的听觉心理评价(P值均＜0.01)、声带的对称性(P=0.000)、平静呼吸时声门宽度(P=0.001)、发声时声门闭合程度(P=0.001)、呼吸功能(P=0.001)的差异均有显著性统计学意义,术后吞咽功能不受影响(P=0.310).术后喉狭窄1例,复发1例,复发率2.1%;颈淋巴转移1例,肝转移l例;死亡2例.Kaplan-Meier法计算3年和5年生存率分别为96.9%、88.9%.结论 喉软骨开窗式喉部分切除术治疗经适当选择的T2-3声门型喉癌,可有效减小创伤并利于患者的呼吸及发声功能的恢复.     

Vocal function after vertical partial laryngectomy with glottic reconstruction by false vocal fold flap: durational and frequency measures.

OBJECTIVE: Compare vocal function following vertical partial laryngectomy (VPL) with or without glottic reconstruction by false vocal fold (FVF) mucosal flap. STUDY DESIGN: Twenty-seven patients with Tla squamous cell carcinoma (SCC) of the glottis were included in a prospective randomized clinical study. All patients were treated by frontolateral partial laryngectomy (FLPL). Glottic reconstruction with FVF mucosal flap was performed in 14 patients at the time of the FLPL, whereas 13 patients had standard FLPL. METHODS: Objective voice assessment was based on computerized acoustic recordings performed before and 1 year after surgery. When possible, additional recordings were performed at 3 months, 6 months, and 2 years postoperatively. Incidence of postoperative granuloma and anterior neoglottic web were noted. Repeated analysis of variance (ANOVA) was used to compare the durational (maximum phonation time, speech rate) and frequency measurements (average fundamental frequency [Fo], standard deviation of Fo, jitter, shimmer, noise-to-harmonics ratio, degree of voice breaks) between patients with or without glottic reconstruction, postoperative granuloma, and anterior neoglottic web. Linear regression was used to study the evolution over time of the durational and frequency measurements. RESULTS: Frequency measurements improved with time and were significantly better in patients treated with glottic reconstruction. In addition, glottic reconstruction decreased incidence of postoperative granuloma and anterior neoglottic web. CONCLUSIONS: The FVF mucosal flap technique can improve vocal results in selected cases of Tla SCC of the glottis when FLPL is the adequate surgical treatment. false vocal folds; glottic reconstruction; vertical partial laryngectomy; vocal function.