喉鳞癌全喉与喉部分切除术的远期疗效分析

目的　回顾分析声门上型及声门型喉鳞癌患者经全喉及喉部分切除治疗后的远期效果 ,提出今后治疗措施。方法　 42 3例喉癌患者中 ,声门上型 32 7例 ,声门型 96例。 2 43例全喉切除患者中 ,声门上型喉癌 2 10例 ,声门型 33例。喉部分切除的 180例中 ,声门上型 117例 ,声门型 6 3例。依照直接法计算出声门上型和声门型喉癌的全喉切除与喉部分切除的 1,3,5年生存率 ,以及各期病例的 3,5年生存率。结果　 32 7例声门上型喉癌术后 5年生存率为 72 9% ,全喉与喉部分切除的 5年生存率分别为 70 1%和 77 4% (P >0 0 5 )。 96例声门型喉癌术后 5年生存率为 86 0 % ,其中全喉与喉部分切除后的 5年生存率分别为 72 2 %和 92 3% (P <0 0 5 )。结论　喉癌治疗仍以手术为主 ,声门上型喉癌的喉部分切除与全喉切除远期疗效大致相等 ,而声门型喉癌的喉部分切除远期疗效明显高于全喉切除。在适应证选择合适的基础上 ,应大力倡导开展有利于患者生存质量的喉部分切除手术。

Long-term results of total versus partial laryngectomy for the treatment of squamous-cell carcinoma of the larynx

Objective To analyze the long term effects of total versus partial laryngectomy for the treatment of squamous cell carcinoma of the larynx. Method Of 423 patients with laryngeal carcinoma surgically treated, 327 had supraglottic cancer and 96 had glottic cancer. Total laryngectomy was performed in 243 patients (210 supraglottic and 33 glottic cancers) and partial laryngectomy in 180 patients (117 supraglottic and 63 glottic cancers). Results The overall 5 year survival rate of patients with supraglottic carcinoma was 72.9%. That of patients treated by total and partial laryngectomy was 70.1% and 77.4%, respectively (P>0 05). The overall 5 year survival rate of patients with glottic carcinoma was 86.0%. That of patients treated with total and partial laryngectomy was 72.2% and 92.3%, respectively (P<0 05). Conclusion The long term result of partial laryngectomy for glottic carcinoma is as good as total laryngectomy, and for suprglottic carcinoma, partial laryngectomy is superior to total laryngectomy. Partial laryngectomy is recommended to treat patients with squamous cell carcinoma of the larynx. Patients so treated have a better quality of life.