声门型喉癌喉部分切除术98例疗效分析

目的 探讨声门型喉癌不同类型喉部分切除术的治疗效果,方法 回顾性分析98例声门型喉癌喉部分切除术的临床资料,总结不同类型喉部分切除术后喉功能恢复情况。结果 98例患者的总拔管率为94．9％,全部患者均获得不同程度的发音功能,发音中等及良好者83例,占84．7％。出现误咽15例,经吞咽训练均恢复正常进食,4例术后1～2年颈部淋巴结转移．2例会厌喉成形术者喉腔局部复发。术后3年和5年生存率分别为86．5％、81．7％。结论 声门型喉癌喉部分切除术在彻底切除肿瘤的同时尽可能地保全了患者的喉功能,提高了患者的生存质量,3年和5年生存率不低于喉全切除术。

Partial laryngectomy for ninety-eight patients with glottic carcinoma of the larynx

OBJECTIVE: To investigate the therapeutic results after various kinds of partial laryngectomy for patients with glottic carcinoma of the larynx. METHODS: From January 1980 to Mar 2004, 98 patients with glottic carcinoma of the larynx were treated by various kinds of partial laryngectomy. The types of operation varied according to stage of the lesion: vertical or frontovertical partial laryngectomy for T1b, T2 and T1a with invasion of anterior commissura, Tuker's operation or supracricoid partial laryngectomy for T1b, T2 or those with invasion of over half of contralateral cord, and extended vertical partial laryngectomy with resection of arytenoids for T3, or with invasion of ipsilateral arytenoids cartilage without involving postcricoid mucosa or posterior commissura. Totally, vertical partial laryngectomy was carried out for 76 patients, extended vertical partial laryngectomy for 7, supracricoid partial laryngectomy for 3 and Tucker's operation for 12. One stage unilateral neck dissection was performed in 5 patients and postoperative radio-therapy was supplemented to 5 (dose 60 Gy). For laryngeal function restoration, pectoro-hyomyo-flap and cricohyoidoepi glotopexy procedures were also performed for some patients. The clinical data of these patients were retrospectively analyzed. RESULTS: The 3- and 5-year survival rate was 86.5% (64/74) and 81.7% (49/60), respectively. The total decannulation rate was 94.9% (93/98), though fifteen patients had had symptoms of aspiration. Swallowing function of all patients recovered to the normal level. The phonation of all patients was restored to various degrees and they were able to communicate socially. CONCLUSION: The 3- and 5-year survival rates of partial laryngectomy for patients with glottic carcinoma of the larynx are comparable to the results achieved by total laryngectomy, but the quality of life of the patents much better. Complete resection of the tumor and simultaneous preservation of respiratory and vocal function whenever possible by partial laryngectomy is very important for improving patients' life quality. With a suitable size and good blood supply, the sternohyoid muscle flap of unipedical and half-thickness instead of whole thickness is ideal in the reconstruction of laryngeal defect after vertical partial laryngectomy.