环状软骨上喉次全切除喉功能重建及疗效观察

目的探讨环状软骨上喉次全切除喉功能重建及疗效。方法回顾分析1998～2005年行环状软骨上喉次全切除并行喉功能重建18例，其中声门型癌12例，声门上型癌6例。采用环状软骨-舌骨-会厌固定术式（CHEP）11例；气管．环状软骨、舌骨会厌固定术式（TCHEP）1例；环状软骨-舌骨固定术式（CHP）6例。结果18例患者术后均拔管，拔管率100％。CHEP术式，拔管时间为14～18d，平均15d；TCHEP术式，拔管时间20d；CHP术式拔管时间18—25d，平均21d。全部病例术后恢复呼吸及发音功能，保留会厌（CHEP，TCHEP）术式，短期误咽发生率为41．6％；切除会厌的CHP术式误咽发生率为100％。按术后8周评价，保留会厌者均无误咽，而切除会厌者误咽发生率占33．3％。术后随访，3年生存率88．8％，5年生存率75％。结论根据喉癌发生的部位和累及的范围选择环状软骨上喉次全切除，采用不同术式和重建方法，既能良好地保留喉功能，又能完整地切除喉肿瘤，是值得推广的一种术式。

Supracricoid subtotal laryngectomy and laryngeal functional reconstruction in the treatment for laryngeal carcinoma

Objective To evaluate the methods and therapeutic effect of supracricoid subtotal laryngectomy and laryngeal functional reconstruction in the treatment for laryngeal carcinoma. Methods Clinical data of 18 laryngeal carcinoma patients treated with supraericoid subtotal laryngectomy and laryngeal functional reconstruction from 1998 to 2005 was studied retrospectively. According to the location of primary tumor, 12 cases were glottic type and 6 were supraglottic type. As for the surgical manner, crieohyoidoepiglottopexy （CHEP） was performed in 11 cases, traeheocricohyoidoepiglottopexy （TCHEP） in 1 case, and cricohyoidopexy （CHP） in 6 cases. Results The decannulation rate was 100 %. The decannulation time ranged from 14 to 18 days with an average of 15 in CHEP group; 20 days in TCHEP group; and ranged from 18 to 25 days with an average of 21 in CHP group. The respiratory and phonatory functions recovered in all the cases. The subtotal short-term aspiration rate of CHEP and TCHEP groups was 41 . 6 % , and that of CHP group was 100 % . Eight weeks after operation, aspiration disappeared in cases of CHEP and TCHEP groups , hut still existed in 2 cases （ 33. 3 % ） of CHP group. Of all the patients, the 3- year and 5- year survival rates were 88. 8 % and 75 % respectively. Conclusion Proper choice of suitable supracricoid subtotal laryngectomy combined with the functional reconstruction can retain the laryngeal functions as well as the complete resection of the tumor.