T3期声门型喉癌的外科治疗选择

目的 探讨T3期声门型喉癌合适的外科治疗方式.方法 回顾性分析57例T3期声门型喉癌患者的临床病理特征、手术方式和预后,分析不同手术方式和不同年龄组患者的3年无瘤生存率.结果 57例T3期声门型喉癌患者全部行喉部手术治疗,失访7例,总的3年无瘤生存率为63.2％(36/57).采用喉全切除术24例,喉近全切除术8例,喉部分切除术25例,3年无瘤生存率分别为66.7％ (16/24)、50.0％ (4/8)和64.0％ (16/25),差异无统计学意义(P =0.694).≥70岁者和＜70岁者的3年无瘤生存率分别为70.0％ (7/10)和61.7％( 29/47),差异亦无统计学意义(P=0.621).36例患者行颈淋巴结清扫术,其中全颈淋巴结清扫2例,改良颈淋巴结清扫6例,分区性颈淋巴结清扫28例,颈部淋巴结转移率为17.5％(10/57).局部复发10例,其中喉部分切除术后7例,喉近全切除术后2例,喉全切除术后1例.结论 喉全切除术与不同的喉部分切除术均是T3期声门型喉癌的重要手术方式,应根据患者局部病变与全身状况的具体情况综合考虑,选择合适的个体化手术方式.≥70岁的T3期声门型喉癌患者,应慎行喉部分切除术,喉全切除术也可以取得满意疗效.

Selection of surgical modalities for T3 glottic carcinoma

Objective To determine the optimal surgical modality for T3 glottic carcinoma.Methods Clinical data of 57 cases of T3 glottic carcinoma were retrospectively reviewed.Their clinical characteristics,surgical procedures and prognosis were analyzed.At different ages and by surgical procedures performed,the 3-year disease-free survival rate of the patients were analyzed.Results All cases underwent surgical procedures including total laryngectomy,near total laryngectomy and partial laryngectomy,and the 3-year disease-free survival rate was 63.2％ (36/57).The 3-year disease-free survival rate of patients who received total laryngectomy was 66.7％ ( 16/24),near total laryngectomy 50.0％ (4/8),and partial laryngectomy 64.0％ ( 16/25,P =0.694).The 3-year survival rate of the cases ≥70.0 years old was 70.0％ (7/10),and that of ＜70 years old was 61.7％ (29/47,P =0.621 ).Thirty-six cases had neck dissection,including 2 cases with radical neck dissection,6 cases with modified neck dissection,and 28 cases with selective neck dissection.The lymph node metastasis rate of all cases was 17.5％.Ten cases were diagnosed as postoperative local recurrence,including 1 cases treated with total laryngectomy,2 cases treated with near total laryngectomy and 7 cases treated with partial laryngectomy.Conclusions Both total laryngectomy and partial laryngectomy are important surgical procedures for treating patients with T3 glottic carcinoma.The optimal individual surgical procedure for the patient with T3 glottic carcinoma should be determined on the basis of the local lesions and physical status.Total laryngectomy is prior to partial laryngectomy for the patients with T3 glottic carcinoma ≥70 years old.