喉软骨开窗式喉部分切除术治疗T2-3声门型喉癌

摘要

Objective To investigate the operative effect and value of window partial laryngectomy for the treatment of stage T2-3 glottic laryngeal carcinoma.Methods From Oct.2000 to Dec.2006,the stage T2-3 glottie laryngeal carcinoma of 48 patients by properly selected were performed with window partial laryngectomy and laryngeal reconstruction.Twenty nine males and 19 females were included.Their ages ranged from 43 to 78 years(median 57.0 years).Before operation and in the 6 months after operation,these targets including auditory mental evaluation of hoarse degree,active degree and symmetry of vocal cord,glottie width in the time of quiet breathing,glottie closing degree in the time of phonating,respiratory function and swallowing function were surveyed.In addition,the things of recurrence and metastasis of tumors together with survival time of patients were following investigated. Results All patients were decannulated successfully and incisions were healed smoothly.No operative complication occurred.Except active degree of vocal cord(P=0.343),there were respectively significant difference between two group targets of auditory mental evaluation of hoarse degree(all P＜0.01),symmetry of vocal cord(P=0.000),glottic width in the time of quiet breathing(P=0.001),glottie closing degree in the time of phonating(P=0.001)and respiratory function(P=0.001)those were investigated before operation and after operation.The swallowing function wasn't influeneed(P=0.310).There were laryngostenosis in 1 case,recurrence in 1 case(2.1%),cervical lymph node metastasis in 1 ease and hepatic metastasis in 1 case.Two cases died.3-year and 5-year overall survival rate were respectively 96.9% and 88.9%.Conclusions The study showed that window partial laryngectomy wag successful for treating stage 32-3 glottic laryngeal carcinoma by properly selected.This operation was effective for reducing surgical invasion and beneficial to resume respiratory and vocal function.%目的 探讨喉软骨开窗式喉部分切除术治疗12-3声门型喉癌的手术效果及其价值.方法 2000年10月至2006年12月采用喉软骨开窗式喉部分切除并同时行喉结构及其功能重建术治疗经适当选择的48例T2-3声门型喉癌,其中男29例,女19例;年龄43～78岁,中位年龄57.0岁.在术前及术后6个月作声嘶程度的听觉心理评价,观察双侧声带的活动度、对称性、平静呼吸时声门宽度和发声时声门闭合程度,评价呼吸和吞咽功能情况;随访肿瘤的复发、转移情况以及患者的生存时间.结果 全部患者顺利拔管,切口均甲级愈合,无手术并发症.患者术后6个月时与术前相比,除声带的活动度外(P=0.343),声嘶程度的听觉心理评价(P值均＜0.01)、声带的对称性(P=0.000)、平静呼吸时声门宽度(P=0.001)、发声时声门闭合程度(P=0.001)、呼吸功能(P=0.001)的差异均有显著性统计学意义,术后吞咽功能不受影响(P=0.310).术后喉狭窄1例,复发1例,复发率2.1%;颈淋巴转移1例,肝转移l例;死亡2例.Kaplan-Meier法计算3年和5年生存率分别为96.9%、88.9%.结论 喉软骨开窗式喉部分切除术治疗经适当选择的T2-3声门型喉癌,可有效减小创伤并利于患者的呼吸及发声功能的恢复.