保留喉功能疗法在喉癌 T3期病例中的应用探讨

目的：探讨在喉癌 T3期病例中 3种保留喉功能的治疗方法的优劣。方法：将保留喉功能的治疗方法分为单纯根治性放疗、根治性放疗失败后挽救性手术切除、部分喉切除术 3种，分析采用此 3种方法治疗的 94例 T3期喉癌病例的总体生存率、原发灶和继发灶复发率、并发症发生率。结果：在声门上型喉癌中部分喉切除术组的生存率优于单纯根治性放疗组 (P=0.0248)；在声门型喉癌中部分喉切除术组的生存率与根治性放疗失败后挽救性手术切除组相当，都高于单纯根治性放疗组 (P=0.0075)；在根治性放疗失败后挽救性手术切除、部分喉切除术组中，并发症发生率分别为 60％、 16.7％，前组高于后组（ P<0.05）；放疗组（包括单纯根治性放疗组和根治性放疗失败后挽救性手术切除组）与部分喉切除术组的原发灶复发率分别为 45.8％、 19.4％，差异有显著性（ P< 0.05）。结论：在 T3期喉癌病例中，上述 3种保留喉功能的治疗方法以部分喉切除术效果最佳。

Modalities of Preserving Laryngeal Functions in Patients with T3 Laryngeal Carcinoma

Objective： The aim of this study was to investigate the best choice of the three treatment modalities of preserving laryngeal functions in T3 laryngeal carcinoma. Methods： There were 94 cases with T3 laryngeal carcinoma (Stage Ⅲ and Ⅳ ) who were treated by three kinds of modalities of preserving laryngeal functions： definitive radiotherapy, salvage surgery for the failures of definitive radiotherapy, partial laryngectomy. We compared their survival curve, recurrence rate of the primary and secondary site, and the complications. Results： The survival curve of the partial laryngectomy groups was better than that of the definitive radiotherapy group in supraglottic carcinoma (P=0.0248). In glottial carcinoma, the survival curve of partial laryngectomy group and salvage surgery group were insignificantly different, both of them were better than that of definitive radiotherapy group (P=0.0075). The complication rate of the salvage surgery group was significantly higher than that of partial laryngectomy group (60％ Vs 16.7％ ); We regarded the definitive radiotherapy group and salvage surgery group as one group, it's primary site recurrence rate was significant higher than that of partial laryngectomy group (45.8％ Vs 19.4％ ). Conclusion： Partial laryngectomy is the most effective way among the three modalities of preserving laryngeal functions to treat T3 laryngeal carcinoma.