声门型喉癌T3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     

喉癌声门型T_3的功能保全手术

的　探讨双蒂双肌瓣在喉癌声门型T3病变切除后的喉功能重建。方法　 1984～ 1992年共68例 ,应用单侧双蒂双肌瓣修复声门型T3病变切除后的创面 ,并成形和扩大患侧梨状窝 ,关闭喉腔前壁。结果　 5年生存率为 73 5 % (5 0 / 68) ,拔管率为 91 2 % (62 / 68) ,发声良好者占 92 6% (63 / 68) ,所有患者均在 7～ 2 0天后恢复经口进食。结论　单侧双蒂双肌瓣对声门型T3病变行喉扩大垂直部分切除术后的修复是目前较理想的方法之一。     

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，对侧声带及构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构状软骨切除，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。     

喉癌喉部分切除术的扩展：1．声门上型喉癌──喉水平垂直部分切除术

对７３例声门上喉癌，已侵及声门区（Ｔ２）、杓状软骨已固定（Ｔ３）、已侵及会厌谷（Ｔ４）者，作声门上水平垂直喉部分切除木，用舌骨肌瓣作残喉修复。３年及５年生存率为７５．３％及６８．８％。术后除管率７４．３％，语音清楚可辨者占８２．４％，术后全部经口进食。     

双蒂双肌瓣在T3和T4喉癌扩大喉部分切除术中的应用

目的 观察双蒂双肌瓣在T3、T4喉癌喉扩大部分切除术中应用的远期疗效。方法 1990年5月—1997年5月对386例喉癌T3、T4病变行喉扩大部分切除术，同时应用单侧或双侧双蒂双肌瓣进行修复喉腔大面积缺损，重建喉功能，手术方法包括：扩大声门上水平喉部分切除术，扩大垂直喉部分切除术，3／4喉部分切除术及喉次全切除术。结果 术后8—12d拔除鼻饲管，气管套管拔除率50．3％(194／386)。3年和5年生存率分别是76．7％(296／386)和55．2％(213／386)，局部复发率为16．6％(64／386)。结论 双蒂双肌瓣扩大了T3、T4喉癌喉部分切除术的适应证，只要把握好双蒂双肌瓣应用的适应证，可使部分晚期喉癌患者免除喉全切除之苦，提高了患者的生存质量，并发症少。     

扩大垂直部分喉切除术治疗T_3声门癌

为探讨部分喉切除术治疗Ｔ３声门癌的可能性，自１９８１年６月至１９９２年１２月，为３２例Ｔ３声门癌施行了扩大垂直部分喉切除术即垂直部分喉切除加杓状软骨及部分环状软骨板切除。喉缺损用舌骨肌瓣修复。３及５年生存率分别为７８．１％及７３．９％。拔管率为８１．３％，发声满意者占８４．３％。所有患者均恢复经口进食。对Ｔ３声门癌有选择地施行扩大垂直部分喉切除术是可行的，可使患者保存喉功能，提高生存质量     

喉癌T3及T4病变功能保全性手术后的喉修复及其生存率

报告对１３８例喉癌Ｔ３Ｔ４病变患者在行功能保全性喉切除术后，以自行设计的舌骨肌瓣来恢复喉功能，结果全部患者的呼吸、发音和吞咽保护等喉功能恢复均满意；５年生存率声门上型为６９％，声门型为７５％。     

声门下癌的临床及其手术治疗

目的 探讨声门下癌的临床特点、手术和重建喉功能的方法及喉声门下部分切除术的可行性。方法 总结 １９８１￣１９９７年声门下癌１３例,Ｔ１－２Ｎｏ６例,Ｔ３Ｎｏ１例,Ｔ３－４Ｎ１－２６例。４例行全喉切除术,９例行喉声门下部分切除术和扩大喉声门下部分切除术（累及气管者）,分别以单侧或双侧皮瓣、肌筋膜瓣整复,喉腔内置“Ｔ”型硅胶管扩张,２￣６个月拨除。其中６例行颈清扫术。结果 除４例全喉切除术者外,余９例     

双蒂双肌瓣喉功能重建法

为完成各型喉癌术后的修复，尤其晚期喉癌病变的修复，对102例各型喉癌及6例梨状南内侧壁癌行喉部分、扩大喉部分、3／4喉、次全喉切除，应用双侧和单侧双蒂双肌瓣行喉功能重建，获得满意效果。术后7～11天拔除胃管，气管套管拔除率为66．7％，5年生存率为76.5％，复发率为13．9％。双蒂双肌瓣的应用，使原来拟行全喉切除的患者，可以行喉部分切除，扩大了喉部分切除的适应证，提高了生存质量及生存率，并发症少。     

改良会厌喉成形术

目的：探讨声门癌Ｔ３病变在喉大部切除后重建喉支架的手术方法。方法：３６例声门癌Ｔ３病变,在喉大部切除后施行改良会厌喉成形术;１一侧甲状软骨全乇除、会厌软骨侧向下移取代;２对侧甲状软骨部分保留,肌筋膜瓣或肌甲状软骨膜瓣修复声带;３会厌前侧缘与甲状软骨前缘对合成锐角前连合,后侧缘与对侧杓部形成后连合,会厌上缘与对侧声带形成新声门。结果：３３例拨管,３０例发声清晰、宏亮且易懂,３例发声低沉沙哑。３年和５     

单蒂胸骨舌骨肌肌筋膜瓣在喉部分切除术中的应用

目的：探讨单蒂胸骨舌骨肌肌筋膜瓣在喉部分切除喉功能重建术中的应用价值。方法：对40例喉癌患者进行手术治疗，根据不同病变情况，采用相应的切除方式，以单蒂胸骨舌骨肌肌筋膜瓣重建喉功能。结果：患者均于术后10－20d拔除鼻饲管恢复正常饮食，无明显进食呛咳；均恢复正常语言交流，未出现喉腔闭锁发声失败者；31例于术后15d-6个月拔除气管套管，2例分别于术后2年和3年拔管，拔管率为82．5％（33／40）。3年生存率为86．6％，5年生存率为72．5％。结论：单蒂胸骨舌骨肌肌筋膜瓣适用范围较广，是喉部分切除喉功能重建较为理想的方法。     

肩胛舌骨肌瓣修复喉部分切除术后缺损

目的：探讨肩胛舌骨肌瓣修复喉部分切除术后缺损的可行性和临床疗效。方法：对24例声门上型、声门型喉癌患者切除肿瘤和受累的软骨，以肩胛舌骨肌瓣修复组织缺损、重建声门。对于一侧杓状软骨固定患者，切除杓状软骨，在取肩胛舌骨肌瓣同时连带切取一小块舌骨，将小舌骨块固定于杓状软骨缺损处，用残余黏膜覆盖之。声门上型T2、声门型T3以上患者术后接受放射治疗(50～60Gy)。结果：随访1～5年，1例声门上型(T3)患者于术后2年9个月死于局部复发，1例声门型(T3)患者于术后4年3个月死于颈部转移和骨转移。拔管率为95．8％。91．7％的患者发声近乎正常或声哑。吞咽功能全部恢复。结论：经过仔细选择病例，肩胛舌骨肌瓣修复喉部分切除术后缺损、重建声门是积极有效和切实可行的。     

Organ preservation surgery for advanced unilateral glottic and subglottic cancer

OBJECTIVES: Functional surgery of unilateral T(2b) to T3 glottic cancer and cricoid chondrosarcoma is possible using the technique of tracheal autotransplantation. The objective of this paper is to report the functional and oncologic outcome of 24 consecutive patients treated with this technique between 2001 and 2007. METHODS: Seventeen patients, of whom nine were previously irradiated, had unilateral glottic cancer with impaired mobility of the vocal fold. Clinical staging was T(2b) to (3)N(0). Seven patients had a chondrosarcoma of the cricoid cartilage. In a first operation, an extended hemilaryngectomy was performed, and a radial forearm flap, comprising a distal fascial and a proximal skin component, was transferred to the neck. The fascial paddle was wrapped around the upper 4-cm segment of cervical trachea, and the skin paddle was used for temporary closure of the extended hemilaryngectomy defect. The definitive reconstruction was performed after 2 to 3 months and consisted of removal of the skin paddle from the laryngeal defect and a transplantation of a patch of revascularized cervical trachea to reconstruct the laryngeal defect. RESULTS: Swallowing and speech were restored after the first operation. The glottic and subglottic airway lumen was restored during the second operation. The tracheostomy could be closed in 20 patients. After a median follow-up period of 33 (range, 1-66) months or almost 3 years, 23 patients remained free of tumor recurrence. CONCLUSIONS: Tracheal autotransplantation can be recommended as a functional treatment for selected T(2b) to T(3) glottic cancers and for unilateral chondrosarcomas of the cricoid cartilage. The technique is oncologically robust while resulting in good postoperative function.     

Tracheal Autotransplantation: A Reliable Reconstructive Technique for Extended Hemilaryngectomy Defects

Objectives: Current surgical treatment for a glottic cancer with significant subglottic extension is a total laryngectomy. The objective of this study was to expand laryngeal conservation procedures by using a reconstructive technique that allows for the repair of hemicricolaryngectomy defects. Study Design: After resection of the ipsilateral thyroid, cricoid, and arytenoid for advanced T3 glottic cancer, the laryngeal defect was reconstructed by means of an autotransplanted segment of trachea in four patients. The reconstruction consisted of a transferable patch that was constructed from a segment of revascularized cervical trachea. Methods: During a 14-day period, a 4-cm segment of cervical trachea was wrapped by a free radial forearm fascial flap. In the second stage, the glottic cancer was removed and the cervical trachea was isolated on its fascial blood supply and transformed into a patch that was used to repair the extended hemilaryngectomy defect. Two different patch designs were used. Two patients underwent reconstruction with a patch augmented at the glottic level (group A); two patients underwent reconstruction without glottic augmentation on the patch (group B). Tracheal continuity was restored by an end-to-end reanastomosis. The postreconstruction morphology of the two patch designs was compared with the preoperative laryngeal morphology. Results: The autotransplantation technique led to complete restoration of the subglottic airway lumen in all four patients. Although the anterior-posterior glottic diameter was reduced by 36% in group A patients and by 43.5% in group B patients, a sufficient glottic airway lumen was obtained. The glottic sphincteric function was restored in both groups. Conclusions: Tracheal autotransplantation may be used reliably to repair hemicricolaryngectomy defects. Augmentation of the patch at the level of the glottis is not essential for successful rehabilitation.     

Clinical study of early laryngeal cancer

We retrospectively analyzed 71 consecutive cases of early laryngeal cancer (stage I or II) that had undergone primary treatment in our department between 1999 and 2004. There were 68 males and 3 females, and their ages ranged from 40 to 85 years of age (average; 67.7 years). Eight patients had the supraglottic type, 61 had the glottic type, and 2 had the subglottic type. Chemoradiotherapy was performed as the primary treatment except in the patients with glottic T1a cancer, who received radiotherapy alone. The 5-year survival rates was 91.1% for glottic cancer (T1a: 100%, T1b: 92.3%, T2: 85.8%) and 75.0% for supraglottic cancer. The local control rate of glottic cancer was 79.6% (T1a: 80.0%, T1b: 74.0%, T2: 85.2%), and significantly higher than that of supraglottic cancer (56.2%, p < 0.05). The laryngeal preservation rate was 84.4% in glottic cancer (T1a: 100%, T1b: 76.9%, T2: 77.5%) and 58.3% in supraglottic cancer, and the difference between T1a and T2 glottic cancer was significant (p < 0.05). Local recurrence and cervical lymph node metastasis were seen in 9 patients and 6 patients, respectively. Distant metastasis occurred in 4 patients, all of whom had the glottic type. Four patients died of their disease, and distant metastasis was the major cause of death in 3 of them. These results indicate that additional treatment should be performed in cases in which radiotherapy/chemoradiotherapy is ineffective and that both in the early stages glottic and supraglottic cancers can be successfully treated by radiotherapy/chemoradiotherapy. The results also suggested that the survival of patients with early laryngeal cancer depends on whether they develop distant metastasis. Introduction of adjuvant chemotherapy to improve their prognosis remains to be assessed.     

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。     

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。     

保留杓状软骨喉次全切除喉功能重建的体会

探讨应用保留杓状软骨的喉次全切除喉功能重建术治疗Ｔ３喉癌的拔管率和３、５年生存率。方法对２０例Ｔ３级喉癌,其中声门型３例,声门上型１７例,根据病变范围行保留单侧或双侧杓状软骨喉次全切除及功能重建术,并设计环咽吻合术式。