保留喉功能的T4声门癌的手术治疗

目的 探讨T4声门癌喉功能保留手术的方法和临床疗效。方法 对1982－1998年间22例T4声门癌患者进行手术治疗，切除肿瘤及受累的软骨和喉外组织，以胸骨舌骨肌筋膜瓣、颈阔肌皮瓣、颈阔肌筋膜瓣、甲状软骨膜瓣、下咽黏膜瓣等修复组织缺损，保留会厌或环状软骨板重建喉功能。全部患者均接受术后放射治疗（5000－6000cGy)。结果 全组病例3年生存率86．4％（19／22），5年生存率75．0％（15／20）。喉功能恢复（吞咽保护、呼吸、发音）为68．2％（15／22），喉功能部分恢复（吞咽保护、发音）31．8％（7／22）。结论 T4声门癌尽管可累及喉软骨和喉外组织，但经仔细选择的病例在彻底切除肿瘤的前提下保留喉功能是可行的。

Preservative surgery of T4 glottic cancer]

OBJECTIVE: To explore new methods of preservative surgery for T4 glottic cancer and to evaluate their long term results. METHODS: 22 cases with T4 glottic cancer were treated surgically from 1982 to 1998. The lesions and involved cartilage and extrinsic laryngeal tissues were removed entirely, the sternohyoid myofascial flap, platysma myocutaneous flap, platysma myofascial flap, thyroid perichondral flap and hypopharyngeal mucosa flap were utilized to restore the defects of larynx, while the epiglottis or lamina of cricoid cartilage were reserved for laryngeal function restruction. RESULTS: The 3- and 5-year survival rates were 86.4% and 75.0% in all cases. 68.2% had laryngeal functions(voice, respiration and deglutition) restored and 31.8% partially restored(voice and deglutition). CONCLUSION: Despite the fact that the T4 glottic cancer usually involved with cartilage and extrinsic laryngeal tissues, preservative surgery can be carried out for the carefully selected cases with the lesions entirely removed.