环状软骨上喉次全切除术及其疗效

目的 探讨环状软骨上喉次全切除术的可行性及其适应证。方法 选择自１９８８～１９９６年不宜行常规水平或垂直半喉部分切除术的Ｔ２和Ｔ３喉鳞癌患者２１例行环状软骨上喉次全切除术。声门上型９例，声门型１０例，跨声门型２例。临床分级：Ｔ２期１６例，Ｔ３期５例。手术切除范围；舌骨、甲状软骨板、会厌前间隙和声门旁间隙，保留环状软骨和至少一侧杓状骨或部分正常会厌软骨。吹功能重建主要采用环状软骨舌根（会厌舌根）吻合

Supracricoid subtotal laryngectomy for the treatment of advanced laryngeal cancers]

OBJECTIVE: This procedure was designed to eradicate the advanced laryngeal carcinomas while preserving the laryngeal physiologic function. The indications and contraindications for the operation were also discussed and evaluated in this paper. METHODS: Twenty-one patients with advanced laryngeal cancers underwent this procedure during the period from 1988 through 1996 in our department. All of the patients were not amenable to conventional partial horizontal and vertical laryngectomies. In those patients, there were 9 supraglottic cancers, 10 glottic cancers and 2 transglottic cancers. Among them, 16 cases had stage T2 lesions and 5 cases had stage T3 lesions. In this procedure, the hyoid and thyroid cartilages were excised in toto, along with both true and false vocal cords, paraglottic space as well as the partial or total epiglottis and the whole preepiglottic space. The cricoid cartilage and at least one arytenoid cartilage were spared. The new larynx was reconstructed by suturing the cricoid and/or epiglottis to the base of the tongue. RESULTS: Of 21 patients, 95% were able to eat normally without aspiration, 90% were decannulated with near normal speech function. In two patients, the tracheotomy tube was reserved, one developed a stenosis, and another had recurrent aspiration pneumonia. No patients experienced local recurrence. Nineteen patients were followed up for at least 3 years, 13 patients achieved 5 years tumor-free survival. CONCLUSION: The term supracricoid subtotal laryngectomy best describes the surgical approach and the reconstruction model of the new larynx. As a useful alternative to total laryngectomy in selected advanced laryngeal cancers, this procedure may greatly improve the quality of life and prolong the life without recurrence.