保留一侧杓状软骨的喉次全切除术的远期疗效观察

目的探讨保留一侧杓状软骨的喉次全切除术的疗效。方法分析82例(Ⅲ期73例，Ⅳ期9例；声门上型71例，声门型6例，跨声门型5例)喉鳞状细胞癌患者施行保留一侧杓状软骨的喉次全切除术的远期疗效。结果82例均恢复了发音及吞咽功能，呼吸功能恢复正常者84．2％(69／82)。82例中发生咽瘘2例，创口感染6例，均保守治愈。82例随访均满5年以上，失访5例，随访率为93．9％。5年内死亡26例，其中喉癌局部复发5例，颈淋巴结转移4例，喉癌复发及颈淋巴结转移4例，其他4例(心功能衰竭、心肌梗死、肺转移、直肠癌各1例)，死因不明4例，失访5例。随访满10年者68例，死亡30例(包括5年内死亡之26例，5年后死于喉癌复发1例，死因不明2例，失访1例)，5、10年生存率分别为68．3％(56／82)及55．9％(38／68)。结论保留一侧杓状软骨的喉次全切除术对于T3及某些经过选择的T4期喉癌是可行的。

An observation on long term results of subtotal laryngectomy with preservation of an arytenoid cartilage

OBJECTIVE: To discuss the long-term results of the subtotal laryngectomy with preservation of an arytenoids cartilage. METHODS: The long-term results of the subtotal laryngectomy with preservation of an arytenoids cartilage were analysed in 82 patients with squamous cell carcinoma of larynx (stage III 73 cases, IV 9 cases; supraglottic type 71 cases, glottic 6, transglottic 5). RESULTS: The functions of speech and deglutition were recovered in 82 patients, and the respirations were normal in 69 of 82 cases (84.2%). Pharyngeal fistula appeared in 2 cases, and the infection of incision wound in 6, but all of them were cured by conservative treatment. All of 82 cases were followed-up for more than 5 years, 5 cases were lost follow-up, so the follow-up rate was 93.3%. 26 patients died of various causes during 5 years after operation. 5 of 26 cases died of local recurrence of laryngeal carcinoma, neck metastasis in 4, others in 4 (cardiac insufficiency, myocardiac infarction, lungs metastasis, rectal carcinoma 1 case, respectively) unknown in 4, lost follow-up in 5.68 patients were followed-up for more than 10 years, 30 cases were dead (26 cases who died of various causes included during 5 years after operation; died of local recurrence in larynx was 1 case, unknown 2, lost follow-up 1, during 5 approximately 10 years after surgery). 5, 10 years survival rates were 68.3% (56/82) and 55.9% (38/68), respectively. CONCLUSIONS: Subtotal laryngectomy with preservation of an arytenoids cartilage is recommended for T3 and some elective T4 laryngeal carcinoma.