喉疣状癌的临床分析

目的：分析喉疣状癌的临床病理特点、手术方式和疗效。方法：经病理证实的喉疣状癌患者10例，5例行垂直半喉+重建术；2例行环状软骨上喉部分切除+环舌会厌吻合术（CHEP）；2例行支撑喉镜下YAG激光声带切除术，其中1例术后放疗，另1例4个月后原位复发，行垂直半喉+重建术后控制；1例行喉裂开声带切除术。结果：所有患者均恢复正常的呼吸和吞咽功能，9例插管患者拔除气管套管后均获得正常的发音功能。术后随访：1例患者原位复发，1例因其他部位肿瘤死亡，2例因心脑血管疾病死亡。全部患者手术部位癌细胞无远处转移，5年生存率75%。结论：喉疣状癌是高分化鳞状细胞癌的一种特殊类型，本病确诊有赖于病理专家与喉科医师密切配合。手术是喉疣状癌主要的治疗方式，在切除肿瘤的基础上保留喉功能，提高患者生活质量     

Nd：YAG激光治疗喉狭窄

自1987年以来，我们应用Nd：YAG激光治疗喉瘢痕狭窄11例，随诊4～8年，效果良好。现报告如下。1临床资料喉癌术后喉狭窄9例，男7例，女2例；年龄47～64岁。均因跨声门型喉癌行次全喉切除术或扩大的半喉切除术。术中采用带状肌肌筋膜修补切除侧声带。8例术后应用放射治疗，术后4个月至半年发生喉狭窄，拔管困难，其中1例拔管半个月后出现呼吸困难，再次行气管切开术，喉瘢痕狭窄多出现在前连合部，呈向心状肥厚的瘢痕组织；1例为膜性瘢痕，声门宽度最大处仅0．2～0．3cm；1例在声门下近前连合处证实癌肿复发，经表面麻醉纤维喉镜下YAG激光…     

垂直部分喉切除术:局部复发危险的分析

早期声门癌保守的喉切除术后局部复发仍是一问题,大组病例报道复发率T_1为2～17%,T_2为4～24%。本文对早期声门癌行垂直部分喉切除者肿瘤部位与局部复发的相关性进行分析,以便术前更准确的估价和选择手术方法。共416例,年龄24～90岁。均未行颈廓清、放疗、化疗。经喉裂开声带切除术。(包括甲状软骨内侧软骨膜)168例,扩大的声带切除术包括前联合、杓状软骨声突或喉室底、或双侧声带。半喉切除术248例,行标准的额侧或额前半喉切除术。结果,65例局部复发(15.7%),补救治疗局部复发控制者55例(84.6%),总的局部     

经口CO2激光治疗侵及前连合的早期声门型喉癌22例

目的　探讨侵及前连合的早期声门型喉癌微创切除的方法及疗效。方法 对确诊为侵及前连合的早期声门型喉癌22例患者,T1级17例,T2级5例,均为N0级。均行经口支撑喉镜下CO2激光切除,术后随访观察1~5年,并对治疗情况进行分析。结果　22例患者手术顺利,术中无严重并发症,术后声音恢复满意,随访1~5年,第1年复发2例,第2年复发1例,第3年复发2例,失访1例。复发后1例再次行激光手术,2例行喉部分切除术,2例行喉全切除术。结论 侵犯前连合的早期声门型喉癌,经术前评估未侵犯甲状软骨、排除喉镜下暴露困难的病例,术中通过喉体按压及组织牵拉等暴露手段,扩大切除范围等方法能顺利完成手术,术后定期复查,局部复发后可再次行补救性手术治疗,整体疗效满意。术前评估和术中暴露是能否完成经口微创切除的关键。     

CO2激光联合低温等离子治疗早期声门型喉癌40例

目的 探讨CO₂激光联合低温等离子治疗早期声门型喉癌(EGC)的临床疗效。 方法 回顾性分析内镜下CO₂激光联合低温等离子治疗的40例EGC患者的临床资料,观察术后治疗效果及复发情况。 结果 所有患者首次手术均为内镜下CO₂激光联合低温等离子切除术,共随访4.2~32.0个月(平均18.6个月)。40例均未失访,复发1次3例,复发2次2例,复发率12.5%。复发后行喉全切除术2例,复发后行喉垂直部分切除术1例,复发后行颈淋巴结清扫术1例,复发后再行CO₂激光联合低温等离子切除术+气管切开术1例。 其中喉全切除再次复发行放、化疗及介入治疗,治疗效果差1例;喉垂直部分切除再次复发后选择放疗1例,治疗情况欠佳;余3例末次手术后恢复良好。术后肉芽组织增生9例,术后出现声带粘连4例。36例患者术后发音功能恢复满意,恢复欠佳2例,复发行喉全切除术后丧失发音功能2例。 结论 内镜下CO₂激光联合低温等离子治疗EGC可弥补激光和低温等离子单一治疗模式的不足、提高手术效率,临床有效可行。     

磷酸钛钾激光声带切除术不同术式的临床特点

目的　探讨支撑喉镜下磷酸钛钾 (potasiumtitaniumphosphate,KTP)激光声带切除术不同术式的选择及愈合过程中的临床特点。方法　选择 76例早期声门型喉癌行KTP激光声带切除术 ,对不同术式术后喉内结构恢复过程、音质变化等进行随访观察记录。结果　Ⅰ型术式 11例 ,3个月后恢复喉的正常结构及功能 ;Ⅱ型术式 5 0例 ,3个月后有声带样粘膜皱襞 (以下称新声带 )形成 ,基本恢复喉的结构 ;Ⅲ型术式 15例 ,6个月后多数形成粘膜隆起 ,但失去运动功能。复发时间集中在术后 2～ 4个月 ,复发率为 6 .7% ,2年及 5年生存率为 10 0 %。结论　KTP激光声带切除术疗效好 ,损伤小。Ⅱ型和Ⅲ型术式在保证根治癌肿的基础上应尽可能保留声带肌。     

高频电刀治疗声门型喉癌的手术方法及预后

目的：探讨高频电刀治疗声门型喉癌的手术方法及预后。方法：对20例声门型喉癌患者,应用高频电刀在皿微支撑喉镜下行声带切除术。结果：所有患者术后随访5个月～6年,喉功能和结构保留良好;1例术后半年局部复发,再行全喉切除术,随访5年未见复发;其余19例（其中2例声带前段轻度粘连）未见局部复发和淋巴结转移。结论：在全身麻醉最微支撑喉镜下,应用高频电刀行声门型喉癌切除手术,疗效较好,且无需投入昂贵设备。     

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”.     

喉部分切除术173例疗效观察

目的 :探讨喉部分切除术治疗喉癌的疗效。方法 :1 73例喉癌患者均行喉部分切除术 ,其中垂直半喉切除术 4 9例 ,水平半喉切除术 39例 ,额侧切除术 4例 ,保留会厌及甲状软骨板后 1 /3的扩大喉切除术 4 7例 ,喉近全切除术 (Pearson手术 ) 1 7例 ,喉近全切除环舌根吻合术 1 7例。结果 :1 6 8例恢复发音功能 ,1 4 5例 3个月内拔除气管套管。 3、5年生存率分别为 79.77%、6 9.94 % ,局部复发率为 1 8.5 0 %。结论 :进行喉部分切除一定要严格掌握各种术式的适应证 ,正确选择术式。在重建喉时 ,尽量恢复喉的发音、括约保护及呼吸功能     

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。     

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.     

Endoscopic laser excisional biopsy for selected glottic carcinomas

From January 1988 to December 1990, 44 previously untreated patients with squamous cell carcinomas (SCCs) of the true vocal cord (33 T1a, 11 Tis) underwent carbon dioxide laser excision. The mean follow-up was 28 months (range, 12 to 44 months). Endoscopic excisional biopsy was the primary treatment in 38 of the 44 patients, whereas postoperative radiotherapy was added in 6 cases in which the pathology report showed positive margins. Recurrent vocal cord SCC developed in 8 (18%) of the cases, with an average interval of 17.8 months. Re-treatment consisted of a second laser excision in 4 cases, radiotherapy in 1, hemilaryngectomy in 1, and total laryngectomy in 2. The definitive cure rate with endoscopic excisional biopsy for the patients originally treated with laser excision alone was 94.7% (36/38). Endoscopic laser treatment for selected glottic SCC proves to be an excellent alternative to radiotherapy or open neck surgery.     

Clinical observation and histological research of vocal cord's reformation after laser cordectomy]

OBJECTIVE: Explore the reformation of new vocal cord after laser cordectomy and the histological change of new vocal cord by animal experiment. METHODS: The reforming course of new vocal cord was observed by follow-up. 4 dogs underwent bilateral cordectomy (type II operation) and their larynx were analyzed anatomically and histologically eight months later. 100 cases who underwent KTP laser cordectomy were divided into 3 types according to the range and depth of the excision. RESULTS: All the dogs had reformation of vocal cords eight months later. On the surface of the reformed vocal cord, no mucous cell but squamous cells was found. Newborn ligament-like connective tissues and loose muscle fibers were found under membrane. Complete reconstruction of larynx was found in 16 cases of type I (16/16) and 54 of type II 86% (54/63). But in type III no new vocal cord was found. CONCLUSION: Formation of the new vocal cord is the result of hypertrophy of the remained vocal cord muscle, influenced by depth of the excised vocal cord using laser. The histological construction is nearly normal cord. Whether or not the laser radiation stimulate the tissue hypertrophy is need more research.     

Our experience in CO2 laser surgery for early glottic carcinoma

In the years 1990-2002 187 patients were treated laser microsurgery due to T1, T2 laryngeal cancer. One of the purposes of this work was analysis of resurgery cases due to recurrence of neoplasmatic process after laser cordectomy, therefore a group of 93 patients, treated in the years 1990-1997 was controlled. The local recurrence of neoplasmatic process was observed in 13 persons. The changes were once more removed in laser microsurgery in 5 patients. In 8 persons total laryngectomy was performed with subsequent radiological treatment. The best results of treatment were observed in patients in whom changes were limited to medial part of vocal cord while recurrences were the most often in patients with anterior commissure lesion. In case of recurrences after laser microsurgery all other kinds of possible treatment can be applied as, partial conventional surgery, total laryngectomy, X-ray therapy or repeated laser microsurgery. Functional evaluation of voice in 64 patients, who due to early stage of carcinoma were submitted unilateral CO2 laser cordectomy, was performed. The appearance and mobility of larynx were registered and evaluated in particular periods post surgery, the patients voices were registered and acoustic analysis submitted. Gradual voice improvement following the wound healing were observed in subjective patients evaluation as in objective one. In many cases very good functional results were obtained, which made possible for patients after CO2 laser cordectomy to continue work requiring good function of larynx. In 43 patients the psychological aspect of laser microsurgery influence was analyzed by use of anonymous questionnaires. It proofed, that in the majority of cases, the laser surgery had no influence for the social and company life of people submitted laser cordectomy. In 7 patients the views of larynx were very specific on the free edge of scar after removed vocal cord--spherical structure of 3-5 mm diameter has appeared in 2 to 6 months after laser cordectomy. In pathological examination--laryngitis chronica, granulatio--was stated. In further observation of patients no recurrences were observed. The described changes resemble granulomas and the most probably are caused by laser ray. Higher power lasers are useful, even when used at the same wattage as older models as they produce less carbonization of tissue during use.     

Treatment of early vocal cord carcinoma: a comparison of apples and apples

Radiation therapy, hemilaryngectomy, and even cordectomy will cure a very large percentage of patients with early vocal cord cancer and preserve the voice. However, hemilaryngectomy and cordectomy are conceded by most surgeons to usually produce a poorer voice, compared to radiation therapy, and the operations are restricted to certain anatomical distributions. Those surgeons advocating hemilaryngectomy or cordectomy have compared their results with radiation therapy series which include a proportion of patients with lesions not suitable for voice-sparing operations. One hundred and thirty-nine patients with T 1-2 carcinoma of the vocal cords with a 2-15 year follow-up, who were treated initially by radiation therapy, were analyzed in detail by initial extent of disease. Patients were identified whose lesions were anatomically suitable for hemilaryngectomy or cordectomy, and results for these patients compared to operative results. Since the curative results with voice sparing by irradiation were at least equal, and since the quality of the voice is thought to be much better, there is little justification for recommending a major operation except in specific situations. Lesions initially suitable for voice-sparing operations which subsequently recur after irradiation can usually be treated by a voice-sparing operation.     

Laryngeal radiation after hemilaryngectomy

Laryngeal radiation was administered to 30 patients after hemilaryngectomy for true vocal cord carcinoma at Washington University Medical Center during the years 1957-1976. Twelve patients were irradiated at the time of gross recurrence and 5/12 (42%) of these patients had recurrence of their disease after radiation. Eighteen patients were irradiated immediately after hemilaryngectomy because positive margins were seen in the hemilaryngectomy specimen and 5/18 (28%) of these had recurrence. All but 1 recurrence occurred within 13 months following radiation. Total laryngectomy salvaged an additional 3 patients for ultimate cancer control in 23/30 (77%). This high dose laryngeal irradiation was well tolerated. A major complication occurred in 1 patient (3%) and consisted of permanent laryngeal edema necessitating tracheostomy but permitting useful speech. Mild complications occurred in 5 patients.     

Vertical partial laryngectomy: a critical analysis of local recurrence

The purpose of this study was to evaluate local recurrence following vertical partial laryngectomies in 416 patients with either T1N0M0 or T2N0M0 glottic carcinoma. Local failure was reported according to the T stage, the precise tumor location within each stage, the true vocal cord mobility, and the surgical procedure performed. No local recurrences were observed among 42 patients who underwent thyrotomy and cordectomy when the tumor was confined to the middle third of the mobile true vocal cord. Local failure occurred in 8 of 111 (7.2%) patients in whom hemilaryngectomy was performed for tumors confined to one mobile true vocal cord. There was a diverse group of lesions within each T stage that responded differently to the surgical approaches. The differences in the initial recurrence rates are discussed in terms of careful preoperative assessment and choice of surgical technique for early glottic carcinoma.     

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     

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