喉部分切除术的远期疗效观察

目的　观察喉部分切除术的远期疗效及喉功能的恢复情况。方法　总结 1986～ 1995年间各种喉部分切除术 379例 ,男 2 90例 ,女 89例。声门上癌 184例 (按 1992年UICC标准T1 8例 ,T2115例 ,T348例 ,T413例 ) ,声门癌 192例 (T1 115例 ,T2 6 3例 ,T313例 ,T41例 ) ,跨声门癌 3例 (T2 1例 ,T32例 )。共 8种术式 ,即声带切除术 2 6例 ,垂直部分切除术 138例 ,额侧切除术 7例 ,声门水平 (喉中段 )切除术 12例 ,声门上水平部分切除术 5 8例 ,水平垂直 ( 3 4)部分切除术 95例 ,喉次全切除环舌根会厌吻合术 2 4例 ,喉近全切除环舌根吻合术 (保留一侧杓状软骨 ) 19例。同期颈廓清术 193例 (单侧12 1例 ,双侧 72例 )。结果　全部病例恢复发音功能。 7～ 2 3d全部克服误咽拔掉鼻饲管 ,36 2例在术后 9d～ 3个月拔除套管 ,另 8例经二次手术修整拔除气管套管 ,拔管率为 97 6 %。 3、5、10年生存率分别为 86 8% ( 32 9 379)、81 3% ( 2 6 6 32 7)、6 9 4% ( 12 0 173)。结论　喉部分切除术是保存喉功能的根治性手术。严格掌握手术适应证、正确选择术式、熟练的手术技巧及完善的修复技术是提高生存质量及疗效的根本。

Long-termfollow-up result of partial laryngectomy

Objective To study the longterm followup result of partial laryngectomy and reservation of laryngeal function Methods Three hundred and seventy-nine patients who underwent partial laryngectomy from 1986 to 1995 were summarized (male 290 cases, female 89 cases) Among them, 184 cases were supraglottic carcinomas (T 1 8 cases, T 2 115, T 3 48, T 4 13, according to UICC in 1992), 192 cases were glottic carcinomas (T 1 115, T 2 63, T 3 13, T 4 1), 3 cases were transglottic carcinomas (T 2 1, T 3 2) In common 8 kinds of operations were performed: 26 cases underwent cordectomy, 138 vertical laryngectomy, 7 frontolateral laryngectomy, 12 horizontal glottic laryngectomy ( middle part of the larynx), 58 supraglottic laryngectomy, 95 horizontovertical (3/4) laryngectomy, 24 subtotal laryngectomy with cricoglossoepiglottic anastomosis, 19 near-total laryngectomy with cricoglossal anastomosis (with reservation of unilateral arytenoid cartilage)193 cases underwent concurrent neck dissection( 121 unilateral, 72 bilateral) Results All cases restored their phonation and overcame aspiration with removing nasal feeding from 7 to 23 days after operations 362 cases were decannulated from 9 days to 3 months after operations Another 8 cases were decannulated after a secondary plastic operation Decannulation rate was 976% The three, five and ten year survival rates were 868%(329/379), 813%(266/327) and 694%(120/173) respectively Conclusion Partial laryngectomy is a kind of radical operation with reservation of laryngeal function Mastering indications strictly, correct operation choices, excellent surgical skills and perfect repairing technique are bases of improving life qualities and curative effect.