喉部分切除术的远期疗效

目的 :评价各种喉部分切除术的远期疗效。方法 :对 1984年 3月至 1998年 3月的 2 6 4例喉癌患者行喉部分切除术。手术方法共 8种 :激光声带切除术 19例 ,喉裂开声带切除术 2 9例 ,侧位垂直喉部分切除术 5 8例 ,前位喉部分切除术 18例 ,声门上水平喉部分切除术 4 2例 ,水平垂直喉部分切除术 2 9例 ,扩大喉次全切除术5 1例 (其中扩大至舌根 2 3例 ,扩大至梨状窝 2 5例 ,扩大至气管 3例 ) ,近全喉切除术 18例。同期行颈廓清术 113例 (14 6侧 ,其中功能性 98侧 ,根治性 4 8侧 )。修补材料有颈部皮肌瓣、颈前肌筋膜瓣、室带下移成形声带、局部喉粘膜、甲状软骨膜、会厌下移等 ,酌情单独应用或联合应用。结果 :所有患者均能讲话 ,进行语言交流。 89例无误咽 ,112例轻度误咽 ,5 7例中度误咽 ,6例重度误咽。拔管率 82 .95 %。 3、5、10年生存率分别为 86 .74 %、78.4 7%、5 3.33%。死亡的主要原因是局部复发和颈淋巴结转移 ,死亡 (包括失访 )的患者中 71.4 %死于 3年内。结论 :喉部分切除术和全喉切除术都是喉癌的根治性手术 ;正确掌握手术适应证是手术成败的关键 ;提高拔管率是提高患者生存质量的重要标志 ;合理地处理颈部淋巴结是提高 3、5年生存率的重要环节。

The long term results of partial laryngectomy

OBJECTIVE: To evaluate the long-term results of various kinds of partial laryngectomy. METHOD: The following-up materials from 264 patients who had undergone partial laryngectomy in this department from 3,1984 to 3,1998 wert analyzed. The pathological diagnosis of all the cases was squamous cell carcinoma. The surgical technique were divided into eight kinds: 1. laser vocal cord ectomy for 19 cases, 2. vocal cordectomy through laryngofissure for 29, 3. laterovertical partial laryngectomy for 58, 4. frontovertical partial laryngectomy for 18, 5. suproglottic partial laryngectomy for 42, 6.vertical-horizontal partial laryngectomy for 29, 7. extended subtotal laryngectomy for 51(extended to the base of tongue 23, to pyriform recess 25, to trachea 3), 8. subtotal laryngectomy for 18 (including 3 cases of middle segment partial laryngectomy and hypopharynx-trachea anastomasis). One hundred thirteen cases (146 sides) received neck dissection simuteniously. The materials that were used to reconstruct the operative defect simply or in combination included cervical myocuteneous flap, cervical myofascia flap, false cord, local laryngeal mucosa, thyroid perchondrium and epiglottis. RESULT: All the patients restored the function of phonation. No aspiration happened in 89 cases,mild aspiration in 112,moderate in 57 and severe in 6 cases. But the aspiration disappeared after a certain time of practice and the swallowing function restored in all patients. The rate of decannulation was 82.95%. The survival rate of 3-year,5-year and 10-year was 86.74% ,78.47% and 53.33%, respectively. The main causes of death were local recurrence and lymphatic metastasis, and 71.4 percent of the death happened in the first 3 years. CONCLUSION: The partial laryngectomy was a racial surgery as the same as total laryngectomy. The key point to success was to apply the operative indication strictly. And the important landmark of the patients' survival quality was the decannulation rate and the restoration of laryngeal functions. Correct management on cervical lymphatic nodes could raise the 3-year and 5-year survival rate.