70岁及以上喉癌患者的喉功能保全手术治疗

目的 分析70岁以上老年喉癌患者行喉功能保全手术的方法及疗效. 方法 136例原发喉癌患者,行声带切除34例,垂直半喉切除28例,喉声门上水平部分切除24例,喉3/4切除15例,次全喉切除29例,全喉切除环咽吻合术6例.T3-4期病灶切除后多采用颈部肌皮瓣修复.术后可在气管套管外放置麻醉气囊,练习进食. 结果 全部患者术后1周均恢复发音功能,92例拔除气管套管.45例有不同程度呛咳,经过吞咽练习后好转,1例失败.围手术期无死亡.3年和5年生存率分别为78.7%和68.5%. 结论 对70岁以上老年喉癌患者,术前评估准确、术式选择和围手术期处理得当,可行喉功能保全.

Conservation surgery of laryngeal function for laryngeal carcinoma in patients aged 70 years and over

Objective To study the therapeutic effects of conservation surgery of laryngeal function for larygeal carcinoma in patients aged 70 years and over. Methods 136 patients aged 70 years and over were collected. Among them, 34 cases underwent vocal cord resection, 28 vertical hemilaryngectomy, 24 horizontal supraglottic hemilaryngectomy, 15 horizontovertical (3/4)laryngectomy, 29 subtotal laryngectomy, 6 total laryngectomy with cricopharyngeal anastomosis.Tissue defects were repaired by use of cervical myocutaneous flap in patients of T3-4 tumor stage. After operation, a special pneumatoeeles was attached on the tracheal cannula when eating.Results All patients had their phonation restored in a week. 92 cases were decannulated. 45 cases had cough and then were improved after respiration training and one case was in failure. No death occurred in the perioperative period. The survival rates were 78.7% at 3 years and 68.5% at 5 years.Conclusions Laryngectomy with reservation of laryngeal function is feasible in senile patients aged 70 years and over under conditions of correct indication, right choice of operation and thoroughly care during perioperative.