声门下喉癌的手术治疗

目的 探讨声门下喉癌手术治疗的方法及其疗效。方法 对14例1989-1998年间山东医科大学附属医院（现名为山东大学齐鲁医院）耳鼻咽喉科手术治疗的声门下喉癌患者进行分析。按1997年UICC修订案分期，T1-2NT5例，T3NO-2 3例，T4NO-1 6例。11例行喉部分切除术，3例行喉全切除术。根据病变范围不同，可扩大切除到气管或甲状腺。采用单蒂胸骨舌骨肌肌筋膜瓣、双蒂胸骨舌骨肌肌筋膜瓣、颈阔肌肌皮瓣、胸锁乳突肌骨膜瓣、甲状软骨膜瓣、会厌下移等方法重建喉功能。5例行颈清扫术。结果 喉功能保留11例，占全部的78.6%。7例拔除了气管套管，拔管率为63.6%。全部14例患者均恢复吞烟功能，全组患者的3年生存率为78.6%（11/14），5年生存率为63.6%(7/11)。结论 多数声门下喉癌在彻底切除肿瘤的前提下保留喉功能是可行的。熟练掌握多种修复方法，择优采用，是提高喉功能保留手术水平的重要保证。

Surgical management of subglottic carcinoma]

OBJECTIVE: To explore the surgical management and evaluate the effect on patients with subglottic cancer. METHODS: Fourteen cases with subglottic carcinoma were treated surgically from 1989 to 1998. There were T1-2N0 lesions in 5 cases, T3N0-2 lesions in 3 cases and T4N0-1 lesions in 6 cases. Eleven cases underwent partial laryngectomy and three cases underwent total laryngectomy. The defects of larynx were reconstructed by using uni-pedicled or bi-pedicled stemohyoid myofascial flap, platysma myocutaneous flap, sternocleidomastoid myoperiosteal flap, thyroid perichondral flap and epiglottis flap accordingly. Unilateral neck dissection was performed on 4 cases and bilateral on one. RESULTS: The function of phonation had been restored in all cases except in 3 patients who underwent total laryngectomy. Seven out eleven(63.6%) were decannulated. The swallowing function was restored in all patients. In all cases the 3 and 5 year survival rates were 78.6%(11/14) and 63.6% (7/11), respectively. CONCLUSIONS: The conservative surgery can be used for the majority of the subglottic carcinoma if the lesions were entirely resected. The proficiency in surgical methods is crucial for the preservation of laryngeal function.