声门型喉癌改良环状软骨上喉部分切除术

目的 探讨改良环状软骨上喉部分切除术对声门型喉癌T1b和部分T2的治疗.方法 采用改良环状软骨上喉部分切除术对25例声门型喉癌患者进行治疗.结果 术后4个月拔管率为100%、6个月进食无误咽.重建的声门裂宽度在0.5～0.8 cm,呼吸正常,发音有嘶哑但表达清楚.结论 改良环状软骨上喉部分切除术对于声门型T1b和部分T2的喉癌是-个有效的治疗手段,术后保留功能的结果可靠,基本上可以克服误吸和拔管困难两大并发症.     

喉狭窄外科手术治疗方法与临床研究

目的：研究分析比较喉狭窄的外科手术方法和临床疗效。方法：回顾性分析36例喉狭窄患者的外科手术治疗方法,其中声门上型4例,声门型18例,声门下型14例。声门上型狭窄患者于支撑喉镜下切除粘连瘢痕;声门型患者因甲状软骨缺损,用会厌软骨或舌骨替代缺损后局部放置扩张子。结果：36例患者中22例一次手术半年后痊愈,顺利拔管;8例患者半年后行多次支气管下喉扩张,在1年后6例拔除气管套管,2例未拔管;6例患者失访。36例患者均有不同程度的声音嘶哑。结论：经临床综合手术治疗喉狭窄疗效可靠,术后拨管率高。     

声门上型喉癌20例临床分析

目的 统计分析声门上型喉癌治疗结果,为临床提供治疗依据.方法 回顾性分析20例声门上型喉癌手术治疗的临床资料,按1997年UICC分期标准进行临床分期,Ⅰ期2例,Ⅱ期5例,Ⅲ期9例,Ⅳ期4例.全部经病理检查证实为鳞状细胞癌.所有患者均经手术治疗.结果 术后3、5年生存率分别为75%(15/20)和60%(12/20),全组喉部分切除术占90%(18/20),部分切除拔管率为89%(16/18).结论 严格掌握适应证,熟练掌握多种修复方法,晚期声门上型喉癌保留喉功能是可行的,在保证患者生存率的前提下提高患者的生活质量.     

喉显微外科激光技术治疗喉癌的临床疗效分析

目的探讨显微镜支撑喉镜下CO2激光手术治疗早期声门型喉癌的临床价值.方法选取该院2009年1月—2011年1月该院耳鼻咽喉科收治的早期声门型喉癌患者32例,进行显微镜下CO2激光手术治疗.结果本组32例患者均经手术治疗成功,咽喉功能恢复良好,住院时间4~9 d,平均(6.1±2.3)d,3例局部复发,复发率相比,差异无统计学意义(P>0.05),无严重并发症发生.结论显微镜支撑喉镜下CO2激光手术治疗早期声门型喉癌具有良好的效果且安全性较好,适合临床推广.     

低温等离子射频消融治疗早期声门型喉癌的疗效观察

目的:探讨低温等离子射频消融治疗早期声门型喉癌的疗效。方法:选取巴彦淖尔市医院2015-02～2019-08期间收治的36例早期声门型喉癌患者,全部患者在支撑喉镜下显微镜辅助行等离子射频消融治疗,观察其治疗情况。结果:36例声门型喉癌,其中Tis期1例,T1a期30例,T1b期5例,1例T1b期术后半年出现复发,行全喉切除后随访2a未见复发,其余35例随访6～48mo,无肿瘤复发或转移。结论:低温等离子射频消融治疗早期声门型喉癌,术中出血量少,术后恢复迅速,并能避免气管切开,是一种有效可行的手术方法。     

声门上型喉癌20例临床分析

目的统计分析声门上型喉癌治疗结果，为临床提供治疗依据。方法回顾性分析20例声门上型喉癌手术治疗的临床资料，按1997年UICC分期标准进行临床分期，I期2例，Ⅱ期5例，Ⅲ期9例，Ⅳ期4例。全部经病理检查证实为鳞状细胞癌。所有患者均经手术治疗。结果术后3、5年生存率分别为75％（15／20）和60％（12／20），全组喉部分切除术占90％（18／20），部分切除拔管率为89％（16／18）。结论严格掌握适应证，熟练掌握多种修复方法，晚期声门上型喉癌保留喉功能是可行的，在保证患者生存率的前提下提高患者的生活质量。     

神经刺激器定位肌间沟臂丛神经干阻滞临床效果观察

目的探讨改良环状软骨上喉部分切除术对声门型喉癌T1b和部分T2的治疗。方法采用改良环状软骨上喉部分切除术对25例声门型喉癌患者进行治疗。结果术后4个月拔管率为100％、6个月进食无误咽。重建的声门裂宽度在0．5—0．8cm，呼吸正常，发音有嘶哑但表达清楚。结论改良环状软骨上喉部分切除术对于声门型T1b和部分T2的喉癌是一个有效的治疗手段，术后保留功能的结果可靠，基本上可以克服误吸和拔管困难两大并发症。     

探讨垂直侧前喉部分切除术术式的改良

目的探讨累及前联合的早期声门型喉癌的手术方法。方法回顾分析9例累及前联合的早期声门型喉癌临床资料,其中T1bN0M05例;T2N0M04例,均行垂直侧前喉部分切除术改良术式。结果经治疗后所有患者发声及吞咽功能得到较好的恢复,拔管率为100%;6例术后出现面颈部皮下气肿,出院前均消失,无其他并发症。随访8个月-4年。结论合理选择最佳的术式,可使患者减轻痛苦,有利于提高生存质量。     

改良喉部分切除术治疗声门型喉癌的疗效分析

目的 探讨保留甲状软骨的喉部分切除术在治疗声门型喉癌中的可行性及其手术效果.方法 回顾性分析1999年1月至2009年1月收治的声门型喉癌患者128例,术中肉眼和病理证实甲状软骨内膜无癌细胞侵犯或甲状软骨局灶性破坏无需大范围切除的T2-3期病例,采用病例对照研究方法,按部位相同、TNM分期相同,年龄相差≤10岁,1∶1配对.研究组为保留甲状软骨的喉部分切除术患者,共64例,其中T2N038例,T2N16例,T2N21例,T3N0 17例,T3N12例;对照组为传统喉部分切除术患者,共64例,TNM分期同研究组.比较两组患者生存率、局部控制率和总拔管率.结果 研究组3年及5年累积生存率分别为89.8％,84.3％,对照组分别为91.5％,85.4％,两组比较差异无统计学意义（x2=1.687,P＞0.05）;研究组局部控制率为91.7％（55/60）,对照组为93.2％（55/59）,两组比较差异无统计学意义（x2=0.103,P＞ 0.05）;研究组总拔管率为98.3％（59/60）,对照组为89.8％（53/59）,两组比较差异有统计学意义（x2=4.933,P＜ 0.05）.结论 对于T2期和部分T3期声门型喉癌患者的治疗,与传统喉部分切除术式相比,保留甲状软骨的喉部分切除术在保证彻底切除肿瘤、保留足够安全缘的同时,保留了喉功能,其术后拔管率高,并发症发生率低,有助于改善喉癌患者术后的生活质量.     

低温等离子微创治疗早期声门型喉癌的近期疗效观察

目的探讨低温等离子手术系统微创治疗早期声门型喉癌的疗效观察。方法对6例早期声门型喉癌行气管切开插管全麻,支撑喉镜下鼻窦内窥镜引导,采用低温等离子EIC7070-01刀切除喉部肿瘤。结果 6例肿瘤术中切缘送病理冰冻切片,5例未见癌细胞残留,1例有癌细胞残留,扩大肿瘤切除范围,再次送病理未见肿瘤细胞残留。结论采用低温等离子EIC7070-01刀切除早期声门型喉癌,方法简单、微创、不出血。术后恢复快,无并发症,保留了较好的发音功能,避免了传统的半喉切除、喉裂开声带病变切除术带来的创伤。     

Contribution of tobacco and alcohol to the high rates of squamous cell carcinoma of the supraglottis and glottis in Central Europe

Incidence rates for laryngeal cancer in Central Europe are among the highest in the world. The authors recruited cases and controls between 2000 and 2002 for the Central and Eastern Europe Multicenter Study to investigate the role of tobacco and alcohol as causes of laryngeal cancer in this region. A total of 384 incident squamous cell cases were included, comprising 254 glottic and 108 supraglottic cancers. Hospital controls were chosen from within the same catchment area, from diseases unrelated to tobacco or alcohol (n = 918). Significant dose-response trends for frequency and duration of tobacco use were observed for both supraglottic and glottic cancers, with potentially a more important effect for supraglottic cancer. Quitting smoking was protective against laryngeal cancers after 5 years. Any increases in risk for alcohol drinking were generally moderate and nonsignificant. A greater than multiplicative interaction was observed between tobacco and alcohol on the risk of laryngeal cancer (p = 0.04). Approximately 87% of laryngeal cancer cases in Central Europe are attributable to tobacco use, of which 75% and 12% are due to current and past smoking, respectively. Approximately 39% are attributable to the interaction between alcohol and tobacco. Preventive efforts to encourage current smokers to quit are likely to be the most effective way to reduce the incidence of laryngeal cancer in this region.     

Differences in the sex ratio of laryngeal cancer incidence rates by anatomic subsite

The incidence data from nine population-based cancer registries participating in the Surveillance, Epidemiology and End Results program in the U.S. suggest that squamous cell carcinoma arising from different parts of the larynx have different etiologic influences. The male to female rate ratio for laryngeal cancers was substantially higher in the glottic region (9.2 among whites and 11.8 among blacks) than in other subsites (approx. 3-5 in both races). The sex rate ratios were uniformly higher for glottic tumors in all age groups, and these ratios increased more rapidly with age for glottic than for supraglottic tumors. Factors that are closely related to sex other than smoking and drinking behavior are responsible for the considerably high ratio of male to female rates of the glottic tumors. Future etiologic studies should investigate the possible differential effect of hormonal or other sex-related factors on different anatomic subsites within the larynx.     

带蒂颈阔肌皮瓣在喉垂直部分切除术中喉缺损修复的应用

目的探讨带蒂颈阔肌皮瓣在喉垂直部分切除术中喉缺损修复的应用。方法回顾分析86例声门型喉癌,其中T1aN0M0 26例,T2N0M0 44例,T2N1M0 3例,T3N0M0 8例,T3N1M0 5例,均行喉垂直部分切除术,用带蒂颈阔肌皮瓣修复缺损。结果3个月后的拔管率为95.3%,进食正常。术后1年发声功能:I、II、III级分别为3.4%、47.7%和40.7%。术后随访满5年48例,3~5年18例,3年内12例,术后2年失访8例。5例术后2年复发,行喉全切除术 颈清扫 放疗,其中3例再次手术后死于远处转移。目前在访人数72例。结论声门型喉癌(T3以下)行喉垂直部分切除术后,带蒂颈阔肌皮瓣是修复喉缺损较好的材料,取材方便、容易制作、容易存活,术后拔管率高、发声良好,而且可以用于较大的组织缺损修复,基本上可以代替以往的其它修复材料,值得推广。     

低温等离子刀用于声门型喉癌手术患者治疗中的临床效果分析

目的:探讨低温等离子刀用于声门型喉癌手术患者治疗中的临床效果。方法:随机选取2017年3月~2019年8月收治的74例声门型喉癌手术患者为研究主体,将其采用随机抽签的方式分组实施研究,每组各37例,抽取单号的对照组采用声门型常规喉癌部分切除术加以治疗,抽取双号的观察组采用低温等离子刀加以治疗,对比两组患者的手术指标及术后并发症发生情况。结果:观察组与对照组手术指标对比可知,前者术中出血量更少,手术时长及住院天数更短(P<0.05);观察组咯血1例,呼吸困难1例,并发症发生率为5.41%,对照组咯血3例,呼吸困难5例,并发症发生率为21.62%,组间差异显著(P<0.05)。结论:声门型喉癌患者采用低温等离子刀治疗可减少出血量,缩短手术时长及住院天数,减少并发症的发生,临床使用价值高。     

Occupational Exposures and Laryngeal Cancer among Non-smoking and Non-drinking Men

Abstract

In a previous hospital-based case-control study, we found an association between laryngeal cancer and exposure to occupational silica, cotton dust, diesel exhaust, gasoline exhaust, and polycyclic aromatic hydrocarbons (PAH). We evaluated the data further to investigate risks from occupational exposure among non-smoking and non-alcohol drinking (NSND) men. We analyzed 189 male NSND primary laryngeal cancer cases and 536 NSND controls. Case group included 86 supraglottic (45.5%), 47 glottic (24.9%), and 56 subglottic and non-classified tumors (29.6%). Age-adjusted odds ratios (OR) and 95% confidence intervals (95%CI) were calculated for occupational exposure. The most prevalent exposures among cases were PAH (40.7%), diesel exhaust (29.1%), and solvents (24.9%). An excess of laryngeal cancer occurred with silica (OR, 1.7; 95%CI, 1.1–13.0) and PAH (OR, 1.5; 95%CI, 1.1–2.2). An observed excess risk from silica and PAH exposure among NSND laryngeal cancer cases supports the suggested link between occupational exposure and laryngeal cancer.     

支气管肺动脉成形术在中心型支气管肺癌治疗中的应用

[目的]探讨支气管肺动脉成形术治疗中心型支气管肺癌的效果。[方法]回顾性分析2001年6月～2009年6月施行支气管肺动脉联合成形肺叶切除治疗的36例中心型支气管肺癌患者的临床资料,其中鳞癌26例,腺癌8例,小细胞未分化癌2例。pTNM分期:Ⅱa期8例,Ⅱb期12例,Ⅲa期16例,行左上支气管肺动脉成形术14例,右上肺动脉支气管成形术22例。[结果]全组无手术死亡病例,术后4例出现肺不张,4例并发肺感染,2例并发心律失常,均经对症、抗感染等处理后治愈,无支气管胸膜瘘、出血等严重并发症发生。术后随访时间5～65个月,平均32个月,全组术后1、3、5年生存率分别为88.9%(32/36)、55.6%(20/36)、44.4%(16/36)。[结论]肺动脉支气管成形术肺叶切除符合最大限度地切除肿瘤又最大限度保留肺功能的基本原则,特别是用于心肺功能储备差、不能耐受全肺切除的局部晚期患者,扩大了手术适应证。     

多层螺旋CT诊断48例胃癌的价值

目的 通过对多层螺旋CT（MSCT）进行前瞻性研究,探讨多层螺旋CT在胃癌诊治中的价值.方法 采用多层螺旋CT进行检查胃癌患者48人.结果 胃壁增厚41例,厚度从3.0～10cm不等,其中37例增厚的胃壁呈不规则状,4例较规则.48例中转移至肝脏4例、肺2例、肾上腺1例;种植转移至网膜、系膜引起其增厚的2例,腹水2例.48例患者中共15例患者24处出现肿大淋巴结.全部病变在CT图像上均显示,均可作出定位诊断,CT定位诊断率为100%.36例行手术治疗者,MSCT评估可切除者即可行根治术者23例,不能切除即行单纯姑息手术者13例,手术证实行根治术者22例,行姑息手术者14例,MSCT术前评估的准确性为94.44%.结论 多层螺旋CT以其独特的优势、强大的后处理功能,可以显著地提高胃癌的检出率和诊断准确率,对于胃癌的术前分期、分型有较大的帮助,是目前最可靠、最具潜力的影像检查方法.     

A study of the interaction of alcohol drinking and tobacco smoking among French cases of laryngeal cancer.

Laryngeal cancer represents an important cause of cancer in France, and the individual effects of alcohol and tobacco on this cancer site are well known. However the problem of the interaction between these agents is less extensively documented, and the role of the high consumptions of alcohol has not been studied frequently. A case-control analysis was undertaken to investigate the joint effect of alcohol and tobacco by comparing 197 glottic and 214 supraglottic cancer cases to 4135 controls representative of the French general population. Heavy drinkers were available from the two groups of cases, the highest alcohol category being equivalent to a consumption of more than 2 litres of wine per day. The relative risks estimated for heavy drinkers and smokers were high, and the results indicated an even stronger effect of alcohol drinking and tobacco smoking on the upper part of the laryngeal region. Additive and multiplicative models were fitted to the data. The multiplicative hypothesis was found to be the most appropriate, implying that the risks associated with alcohol and tobacco multiply when the exposures occur simultaneously. The public health implications of this result and the contribution of heavy drinkers and smokers to the frequency of upper respiratory and digestive tract cancers are discussed.