垂直半喉切除术患者鼻音的定量评价

为探讨定量评价喉癌患者行垂直半喉切除术后鼻音变化的方法，选择３０例行此术患者按术后时间长短分Ａ、Ｂ两组，采用鼻声图仪行声功能检测；并以３０例正常人（Ｃ组）作对照。结果示：三组鼻音句与非鼻音句的鼻音强度无显著性差异（均Ｐ〉０．０５）而〔ｉ：〕音鼻音率Ａ、Ｂ两组显著低于Ｃ组（分别Ｐ〈０．００１和Ｐ〈０．０５），Ａ组又显著低于Ｂ组（Ｐ〈０．０１）。表明喉癌患者行垂直半喉切除术后声功能下降明显，但随时间延     

垂直部分喉切除术后声功能的客观定量评价

为客观定量评价喉癌生趣部分喉切除术后患者的发音功能，采用喉声气流仪分别对行垂直半喉切除术后的喉癌患者３０例（按术后２年，３￣１０年分为Ａ、Ｂ两组），和正常男性（Ｃ组）３０例进行声功能测试。结果显示：Ａ、Ｂ组与Ｃ组比较平均气流率（ＭＦＲ）、声强、最长发音时间（ＭＰＴ）有极显著性差异（Ｐ〈０．０１）；发声频率之间有显著性差异（Ｐ〈０．０５）；Ａ组与Ｂ组比较其声强、ＭＦＲ、ＭＰＴ有极显著性差异（Ｐ〈０．     

喉癌下咽癌患者一级亲属染色体对致突变物的敏感性观察

为探讨遗传因素与喉癌下咽癌的关系，检测了几组不同人群淋巴细胞染色体对致突变物诱发畸变的敏感性，结果：喉癌组、下咽癌组及对照组每细胞染色单体断裂率（ｂ／ｃ值）分别为０．６１±０．２７，０．６６±０．３１和０．２８±０．１２。喉癌和下咽癌的一级亲属组（亲属组）的ｂ／ｃ值为０．４５±０．２６。把健康一级亲属的喉癌、下咽癌患者从喉癌组和下咽癌组中抽出另列为患者组，其ｂ／ｃ值为０．５９±０．２９。亲属组与患者组比较ｂ／ｃ值差别无显著性（Ｐ＞０．０５），但明显高于健康对照组（Ｐ＜０．００１），明显低于喉癌组和下咽癌组（Ｐ＜０．０１）。结果显示喉癌和下咽癌患者及其健康一级亲属对致突变物敏感性均高于健康人，因此喉癌下咽癌患者的一级亲属应列为患癌高风险人群，注意预防癌肿的发生。     

喉癌引流淋巴结中巨噬细胞对自体肿瘤杀伤活性检测

本实验采用细胞培养技术，从喉癌患者颈廓清淋巴结中提取的巨噬细胞（Ｍｐｈｉ）作效应细胞，喉癌患者自体癌细胞及Ｋ５６２细胞作靶细胞，分别混合培养（两组加ＰＨＡ作为刺激原），结果表明：喉癌患者颈部肿大淋巴结Ｍｐｈｉ对自体癌细胞（３５例）及Ｋ５６２细胞（３０例）均有杀伤能力；此外，我们还对比了未转移淋巴结（Ｎ０组，１８例）与转移淋巴结（Ｎ＋组，１７例）Ｍｐｈｉ杀伤能力，结果Ｎ０组高于Ｎ＋组，差异非常显著（     

喉癌患者红细胞免疫功能的检测

为观察喉癌患者的红细胞免疫功能，对３０例喉癌患者进行红细胞Ｃ＿３ｂ受体花环率（Ｃ＿３ｂ受体花环率）和红细胞免疫复合物花环率（ＩＣ花环率）检测。结果表明，喉癌患者Ｃ＿３ｂ受体花环率加ＩＣ花环率均较声带息肉患者和正常对照组降低（Ｐ＜０．０１）；喉癌患者术后２０天左右Ｃ＿３ｂ受体花环率和ＩＣ花环率较术前无明显改变（Ｐ＞０．０５）。结果提示喉癌患者红细胞免疫功能低下。     

喉癌患者红细胞免疫功能的检测

为观察喉癌患者的红细胞免疫功能，对３０例喉癌患者进行红细胞Ｃ３ｂ受体花环率（Ｃ２ｂ受体花环率）和红细胞免疫复合物花环率（ＩＣ花环率）检测。结果表明，喉癌患者Ｃ３ｂ受体花环率加ＩＣ花环率均较声带息肉患者和正常对照组降低（Ｐ〈０．０１）；喉癌患者术后２０天左右Ｃ３ｂ受体花环率和ＩＣ花环率较术前无明显改变（Ｐ〉０．０５）。结果提示喉癌患者红细胞免疫功能低下。     

喉癌患者机体免疫状态的研究

采用放射免疫扩散法、碱性磷酸酶－抗碱性磷酸酶法和乳酸脱氢酶法，对６８例喉癌患者进行机体免疫状态研究，结果：ＣＤ３＾＋、ＣＤ４＾＋细胞和ＮＫ细胞活性均较对照组明显低下（Ｐ〈０．０１），ＣＤ８＾＋细胞较对照组稍有增加但无显著性差异（Ｐ〉０．０５）；ＩｇＧ、ＩｇＡ、ＩｇＭ较对照组稍见低下但无显著性差异（Ｐ〉０．０５）。提示：喉癌患者细胞免疫水平低下，ＣＤ４＾＋／ＣＤ８＾＋比值下降，机体免疫系统处于被抑制     

喉癌患者的血小板聚集功能检测

以二磷酸腺苷（ＡＤＰ）及胶原为聚集剂，检测了８７例喉癌患者的血小板聚集功能，并与１６６例正常人和３０例头颈良性肿瘤对照，结果：①喉癌疗前组、复发组及转移组的血小板聚集功能比正常人组、头颈良性肿瘤组及喉癌疗后显著增高（Ｐ〈０．０１）；②喉癌患者的血小板聚集功能随临床分期的进展而升高。这些结果可作为喉癌发生、发展、复发、转移与疗效预后的参考。讨论了血小板与癌细胞间相互作用的机制，喉癌患者血小板聚集功能     

术中输血对喉癌患者细胞免疫功能的影响

目的 :探讨术中输血对喉癌患者细胞免疫功能的影响。方法 :利用 EPICS- XL 型流式细胞仪对 36例喉癌手术患者于术前及术后 2周进行 T细胞亚群、NK细胞和 CD2 8测定 ,并与正常人及术中输异体血和非输血者进行比较。结果 :136例喉癌患者术前 CD3、CD4、NK细胞、CD2 8下降 ,与对照组比较 ,其差异均有显著性意义 (P<0 .0 1和 0 .0 5 )。 2输异体血组输血后 CD3、CD4、NK细胞、CD2 8下降 ,与治疗前喉癌组比较 ,其差异亦有显著性意义 (均 P <0 .0 5 )。 3非输血组术后 CD3、CD4、CD8、NK细胞、CD2 8与治疗前喉癌组比较 ,其差异均无显著性意义(均 P >0 .0 5 )。结论 :喉癌患者的细胞免疫功能普遍低下 ,术中输异体血会使患者的免疫功能进一步降低 ,使喉癌易于扩散与转移 ,应引起高度重视。     

喉癌临床N0患者颈淋巴结转移的病理研究

目的探讨喉癌临床Ｎ０患者颈淋巴结转移特点,为颈淋巴结处理方式选择提供根据。方法４０例临床Ｎ０喉癌患者被随机分为选择性根治性颈廓清术（ｒａｄｉｃａｌｎｅｃｋｄｉｓｅｃｔｉｏｎ,ＲＮＤ）及功能性颈廓清术（ｆｕｎｃｔｉｏｎａｌｎｅｃｋｄｉｓｅｃｔｉｏｎ,ＦＮＤ）两组,分别完成１３及２７例。将获得淋巴结逐一行病理检查,以确定转移情况。结果ＲＮＤ组平均每侧获淋巴结３４．２枚,ＦＮＤ组为２７．４枚,差异无显著性（ｔ＝０．８６,Ｐ＞０．０５）。两组颈淋巴结转移率分别为３０．８％（４／１３）及３３．３％（９／２７）,总转移率为３２．５％（１３／４０）。１３例颈淋巴结转移阳性病例中１２例（９２．３％）转移淋巴结位于Ⅱ,Ⅲ区。３３枚转移阳性淋巴结中３２枚（９６．９％）位于第Ⅱ和Ⅲ区。两组３年生存率分别为６９．２％（９／１３）及７７．８％（２１／２７）,统计学差异无显著性（χ２＝０．３４１８,Ｐ＞０．５）,总的３年生存率为７５％（３０／４０）。结论对临床Ｎ０喉癌患者行肩胛舌骨肌上或侧颈廓清术较为适宜。     

老龄喉癌患者喉近全切除术远期疗效观察

目的：探讨老龄喉癌患者行喉近全切除术的远期疗效。方法：对12例65岁以上喉癌患者行喉近全切除术，在Pearson手术基础上，保留部分环状软骨板、环杓关节及喉返神经。结果：3、5年生存率为75．0％及66．7％。术后2周内全部恢复吞咽功能。10例获得理想发声，2例发声失败。结论：对于有心、肺、脑等基础疾病的老龄喉癌患者，喉近全切除术是一种较好的方法。     

喉全切除术在治疗中晚期喉癌中的应用

目的:探讨喉全切除术治疗中、晚期喉癌的疗效。方法:对573例喉癌患者行喉全切除术,声门上型370例,声门型90例,跨声门型75例,声门下型21例,放疗后复发17例。其中143例行单纯喉全切除术,430例同期行颈廓清术(单侧239例,双侧191例)。在喉全切除术中行气管外口造大孔术,共308例。结果:3、5及10年生存率分别为69.5%(398/573),61.1%(350/573),46.3%(149/322);220例死亡病例中,45.0%(99/220)死于局部复发;22.3%(49/220)死于颈部转移。术腔感染和咽瘘的发生率分别为12.2%,5.2%。16.6%气管外口造大孔术患者气管外口再度狭窄需行Ⅱ期气管外口扩大术或戴套管维持呼吸。13.6%的患者可以行喉部分切除术,由于不同的原因行喉全切除术。结论:喉全切除术作为治疗中、晚期喉癌的主要手段,其适应证随喉癌外科技术的发展而逐渐缩小。在采取积极的颈廓清术情况下,局部复发是主要的死亡原因。     

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。     

次全喉切除双颈阔肌皮瓣喉重建术的临床应用

目的 探讨T4声门区喉鳞状细胞癌次全喉切除双颈阔肌皮瓣喉重建术临床应用的可行性、技术操作及疗效。方法 选择13例T4声门区喉鳞状细胞癌施行全次全喉切除双颈阔肌皮瓣喉重建术。结果 13例患者术后发音成功率为100％,其中11例言语可接受度达7级,言语可理解度为95％以上,余2例言语可接受度为5级,言语可理解度为90％以上。误咽发生率为15．4％（2／13）。3年复发率为23．1％（3／13）,3年、5年生存率分别为84．6％（11／13）和76．9（10／13）。结论 该术式扩大了常规次全喉切除术的适应证,有效地恢复喉的全部功能,提高中层得术后生存质量,值得推广应用。     

Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence?

Pharyngocutaneous fistula is the most common complication (8.7 to 22%) in the immediate postoperative period following total laryngectomy. The study's objective was to determine the incidence of post-laryngectomy fistulas in patients operated on in our department to establish whether specific factors predispose to fistula formation and to determine whether fistulas and tumor recurrence are related. Between 1992 and 2001, 377 cases of laryngeal carcinoma were diagnosed, and the patients underwent total laryngectomy in our department. Of these patients, 291 had total laryngectomy as the primary management of their disease, while in 86 patients the operation treated recurrence of the disease. In 92 patients, total laryngectomy was combined with radical or eclectic neck dissection. The presence of early postoperative fistula was established in 49 of the 377 patients (13%) studied. The cancerous stage, exact localization of the tumor, degree of differentiation, previous irradiation, patient's age, performance or not of neck dissection or emergency tracheostomy and fitting of voice prostheses were all factors that, after statistical analysis, did not appear to significantly influence the incidence of postoperative fistulas. Factors that did show statistical significance were the histological infiltration of the tumor's surgical margins (11% negative vs. 38% with positive margins) and coexisting early complications. Fistula management was conservative in the majority of cases. The necessary closure period for a fistula varied between 5 and 81 days (mean: 29 days). Postoperative follow-up of all patients revealed that fistulas did not influence the incidence of tumor recurrence. The incidence of postoperative fistulas in our study was 13%. Incomplete excision of the tumor and coexisting complications were related, among other things, to a higher rate of fistula formation. The rate of tumor recurrence after total laryngectomy was not related to the presence of a fistula during the postoperative period.     

Quality of life correlates after surgery for laryngeal carcinoma

OBJECTIVES: To assess the correlation of operation mode, postoperative radiotherapy, and disease stage factors with the health-related quality of life (HRQL) measures after surgery for laryngeal carcinoma. STUDY DESIGN: Reanalysis of data of two multi-institutional cross-sectional studies. PATIENTS AND METHODS: We interviewed 218 laryngectomees and 153 partial laryngectomy patients in and near Leipzig, Germany, in two cross-sectional studies, using the general and the head- and neck-specific quality of life questionnaires of the European Organization for the Research and Treatment of Cancer (EORTC QLQ-C30 and EORTC QLQ-H&N35). Multifactorial univariate and multivariate models were calculated, with laryngectomy vs. partial laryngectomy, radiotherapy (irradiated or not), and disease stage (International Union Against Cancer [UICC] stages I/II vs. III/IV) as influencing factors and the HRQL scales and items as dependent variables. Analyses were adjusted for the patient's age and the time elapsed since the operation. RESULTS: Laryngectomees were more affected in their sense of smell (P < or = .000). Among irradiated patients, functioning levels and many symptom scales showed worse results (P < or = .05). Both operation mode and postoperative radiotherapy were independently associated with head- and neck-specific HRQL in multivariate analysis. Differences between disease stage groups, however, were not significant. Patient's age was an influencing factor on HRQL, but time since operation was not. CONCLUSIONS:: Postoperative radiotherapy seems to have the greatest impact on patients' HRQL independent of other clinical factors following surgery for laryngeal carcinoma. Aftercare of irradiated laryngeal carcinoma patients should focus more on the patient's quality of life.     

Blood transfusion and laryngeal cancer

Evidence exists to suggest a detrimental effect of blood transfusion on survival after resection for malignant disease. Immune suppression due to transfusion has been implicated, though this remains unproven. We have conducted a retrospective study of 69 patients (38 transfused, 31 not transfused) with squamous carcinoma of the larynx to assess the effect of blood transfusion on survival after laryngectomy. Patients were compared for age, sex, smoking habit, tumour site and stage, grade of operating surgeon, preoperative haemoglobin, tumour nucleolar organizer region status, and operation time. The minimum follow-up was 5 years. In the transfused group 21/38 died as a result of their malignant disease and only 4/31 in the untransfused group. This difference was highly significant (P less than 0.001, chi-squared test) and using a multivariate analysis the only variable associated with a decreased survival time was whether a blood transfusion had been received. We conclude that peri-operative blood transfusion is associated with decreased survival after laryngectomy. However, whether this association is causal remains unproven.     

改良环状软骨上喉部分切除术治疗中晚期喉癌的疗效及生存质量评估

目的　评价改良环状软骨上喉部分切除对中晚期喉癌的生存率及生存质量的效果。方法　回顾性统计分析2002～2015年本院经治中晚期喉癌行改良环状软骨上喉部分切除手术患者共65例,其中男62例,女3例;年龄35～80岁;T2级患者26例,T3级32例,T4a级7例。并与同期120例行喉垂直部分切除手术患者的术后功能效果进行对 比。结果　T2～T4级喉癌患者行改良环状软骨上喉部分切除术后的5年累积生存率是82.3%,拔管率为98.3%,喉垂直部分切除手术患者的拔管率为86.1%,改良环状软骨上喉部分切除术后拔管率明显优于喉垂直部分切除手术组（P <0.05）。两组患者术后发音质量,误咽情况比较无明显差别（P >0.05）。结论　改良环状软骨上喉部分切除是治疗中晚期喉癌可行的手术方式。     

喉咽癌手术及综合治疗的临床资料分析

OBJECTIVE: To investigate the preservation of laryngeal function for the patients with hypopharyngeal cancer. METHODS: Two hundred and ninety-three cases of hypopharyngeal cancer with surgical management were reviewed retrospectively, and 222 cases were originated from pyriform sinus, 13 from post-cricoid, and 21 from posterior pharyngeal wall. Radiotherapy (37 cases), operation only (56 cases) and the combined treatment (operation plus radiation or chemotherapy, 200 cases) were adopted. 159 cases were treated with function preserved laryngectomy and 97 with total laryngectomy. RESULTS: The 5 year survival rates of patient with laryngeal function preserved and no laryngeal function preserved were 51.3%, 47.6% (for stage III); 40.4%, 43.3% (for stage IV), respectively. There were no significant differences in 5-year survival between the functionally preserved group and no functioned group (P > 0.05). The analysis of survival rates revealed a significant difference between combined therapy and radiotherapy. CONCLUSION: There is no significant difference between the survive rates of function preserved and non-preserved groups. Conservation laryngectomy improves the quality of patient's life, and combined therapy is the best choice for hypopharyngeal cancer.     

保留一侧杓状软骨的喉次全切除术的远期疗效观察

目的探讨保留一侧杓状软骨的喉次全切除术的疗效。方法分析82例(Ⅲ期73例，Ⅳ期9例；声门上型71例，声门型6例，跨声门型5例)喉鳞状细胞癌患者施行保留一侧杓状软骨的喉次全切除术的远期疗效。结果82例均恢复了发音及吞咽功能，呼吸功能恢复正常者84．2％(69／82)。82例中发生咽瘘2例，创口感染6例，均保守治愈。82例随访均满5年以上，失访5例，随访率为93．9％。5年内死亡26例，其中喉癌局部复发5例，颈淋巴结转移4例，喉癌复发及颈淋巴结转移4例，其他4例(心功能衰竭、心肌梗死、肺转移、直肠癌各1例)，死因不明4例，失访5例。随访满10年者68例，死亡30例(包括5年内死亡之26例，5年后死于喉癌复发1例，死因不明2例，失访1例)，5、10年生存率分别为68．3％(56／82)及55．9％(38／68)。结论保留一侧杓状软骨的喉次全切除术对于T3及某些经过选择的T4期喉癌是可行的。