老年人喉癌喉切除术的疗效分析

目的探讨老年喉癌患者行喉切除术的疗效和可行性。方法回顾性研究上海交通大学医学院附属第九人民医院奉城分院耳鼻咽喉科和上海交通大学医学院附属第九人民医院耳鼻咽喉科自1996年至2009年的122例60岁及以上的接受各种喉切除手术的老年人喉癌患者，其中男117例，女5例；年龄60～94岁，中位年龄68岁；95例（77．9％）患者有全身合并症。按2002年国际抗癌联盟（international union against cancer，UICC）标准，I期16例，Ⅱ期24例，Ⅲ期52例和Ⅳ期30例。在彻底切除病变的基础上，尽量保留喉的正常组织和喉的功能，切除时保留安全缘≥5mm。采用三种手术方式：经口支撑喉镜显微镜下激光喉癌切除术（10例）、喉部分切除术（25例）和全喉切除术（87例），同时参照2004年大连会议标准行颈淋巴结清扫术。结果122例患者术后伤口I级愈合114例（占93．4％）；Ⅱ级愈合5例；Ⅲ级愈合3例，其中2例发生咽瘘，经积极换药的处理和营养对症支持治疗，2w后创面愈合。所有患者进食均无困难，围手术期均无合并症的加重与恶化。本组1、3、5年随访率分别为100％（122／122）、97．2％（106／109）、92．9％（91／98），采用直接法统计生存率，失访按死亡计算；1、3、5年生存率97．5％（119／122）、84．4％（92／109）、68．4％（67／98）。结论老龄不是喉癌患者行喉切除术的禁忌证，在有充分的术前准备、严格掌握适应证和积极的围手术期处理的前提下，手术仍是治疗老年喉癌患者的主要手段。

The follow up result of laryngectomy in aged patients with laryngeal carcinoma

Objective To study the follow up result of laryngectomy in aged patients with laryngeal carcinoma. Methods 122 patients （aged 〉I 60 years） underwent laryngectomy from 1996 to 2009 were summarized （117 male cases, 5 femal cases）. All patients with squamous cell carcinoma of larynx were conformed while 95 cases （ 77.9% ） suffered from other concurrent diseases. They were classified according to UICC （international union against cancer） standard （2002） into： 16 cases of I, 24 cases of II, 52 cases of III, and 30 cases of IV, respectively. In common 3 kinds of operations were performed： 10 cases underwent transoral laser laryngetomy, 25 partial laryngectomy and 87 total laryngectomy while the safety margin was ≥5 mm. Concurrent neck dissections were performed according to Dalian standard （2004） if it was necessary. Results Among 122 cases, 114 cases got wound healing of grade I （93.4 %）, 5 cases grade II, 3 cases grade III （2 cases with pharyngeal fistula had recovery after 2 weeks caring for）. All patients had not aggravated with concurrent diseases. Through periodic review of out-patient clinics or telephone follow-up, family members follow-up a variety of ways, one, three and five years follow-up rate： 100% （122/122）, 97.2% （106/109）, 92.9% （91/98）, dollars lost to death. The one, three and five years survival rates were 97.5% （119/122）, 84.4% （92/109） and 68.4% （67/98）, respectively. Conclusions Senility is not a contraindication for laryngectomy with reservation of laryngeal function. With sufficient preoperative preparation and peroperative period strategy, laryngectomy is a main method for aged patients with laryngeal carcinoma.