喉部分切除术252例疗效观察

目的：探讨喉部分切除术治疗喉癌的远期疗效和功能恢复.方法：对2000年2月-2008年2月本院收治的252例行喉部分切除术患者的临床资料进行回顾性分析,其中水平半喉切除术117例,垂直半喉切除术82例,喉冠状位切除术17例,环状软骨上喉部分切除术36例.对于T2、T3病变的喉癌均行颈部淋巴结廓清术.对于喉部分切除后行残喉的缺损修补,主要应用术腔切除病灶后的残留黏膜、梨状窝黏膜、颈前带状肌瓣、会厌及舌骨肌瓣.术中明视下病灶切除,确保5mm安全切缘.结果：229例患者术后3月内拔除气管套管,15例患者经激光切除术腔形成的狭窄部位后拔管,8例患者未能拔管,拔管率为96.8％.术后局部复发54例,复发率为21.4％.8例失访病例按死亡病例计数,术后3年生存率为78.2％,5年生存率为67.5％.结论：喉部分切除手术是功能保全性喉恶性肿瘤根治的有效术式,应严格把握适应证,选择合理的手术方式,提高治疗效果.

Clinical observation of 252 cases of partial laryngectomy

Objective： To discuss the partial laryngectomy therapy long - range treating effect and function recover- y. Methods： For 252 cases of partial laryngectomy patients, we held the retrospective analysis for clinical data inclu- ding 117 cases underwent horizontal partial laryngectomy, 82 underwent vertical hemilaryngectomy, 17 cases under- went coronary partial laryngectomy, 36 cases underwent extended partial laryngectomy. For the T2. T3 phase, we all held the neck dissection. For the residual laryngeal patch, we applied the peripheral mucosa, pyriform fossa mucosa, anterior strap muscle flap, epiglottic hyoid muscle flap for the reconstruction after the tumor removed. During the oper- ation,we resected the tumor carefully with 5ram safety margin. Results：All 229 patients were successfully detubated after the operation in 3 months, 15 patients were detuhated through the laser resection for the narrow part in larynx formed after the operation,8 patients failed to be detubated, the detubating rate was 96.8%, 54 cases recurred after the operation,the recurring rate was 21.4%. 8 cases without follow- up were taken into count died cases,the post - operative survival rates of 3 years and 5 years were 78.2% and 67.5%. Conclusion ：The partial laryngectomy opera- tion is a kind of effective operating style for the function - reserved laryngeal malignant tumor radical treatment, we should take into the indication strictly, choose the proper operating style.