喉环状软骨上部分切除-环舌骨吻合术治疗中、晚期喉癌及发声功能重建效果研究

摘要

目的 探讨喉环状软骨上部分切除-环舌骨吻合术(supracricoid partial laryngectomy-cricohyoidopexy,SCPL-CHP)并Ⅰ期喉发声功能重建术的适应证及疗效.方法 对22例中晚期喉癌患者进行SCPL-CHP并Ⅰ期喉发声功能重建术.术后通过言语可懂度和电声门图检查对远期疗效和喉功能恢复情况进行评估.结果 22例患者于术后14～32天拔除气管套管,平均22天;术后18～37天拔除鼻饲管,平均28天,拔管率为100%.22例患者术后发声成功率为100%,术后1年19例言语可懂度达95%以上,3例言语可懂度为90%以上.术后1年电声门图示F0和NNE无明显变化,Jitter、Shimmer和NNE显著降低.术后随访3年以上,除1例失访、1例术后2年死于心脏病外,余20例均无肿瘤复发,3年生存率95.45%.结论 SCPL-CHP并Ⅰ期喉发声功能重建术保留了喉的呼吸、发声等基本功能,术后3年存活率高,是一种较理想而实用的喉癌治疗术式.%Objective To study the long term results of SCPL-CHP for laryngeal cancer. Methods The long term results of SCPL-CHP were analyzed in 22 patients with squamous cell carcinoma of larynx( stage Ⅲ 16 cases , Ⅳ 6 cases ) . The long term results of operation and giottic reconstruction were evaluated by Postoperative Visiting, semi-quantitative Speech Intelligibility analysis and Electroglottograph (EGG). Results The time of decannulation was from 14 days to 32days (mean 22 days). The time of removing feeding tube was from 25 days to 57 days (mean 41 days) , and the decannulated rate was 100％. All 22 patients could communicate with their artificial voice. The speech intelligibility of 19 cases was more than 95％, and 3 cases were more than 90％. EGG parameters were checked after 2 years. FO and NNE were not significantly different, and Jitter and Shimmer significantly reduced. 3-years survival rate was 95.45 ％. Conclusion SCPL- CHP can apply to patients with advanced laryngeal cancers with the survival rate more than 3 years compared with total larygectomy , and also can be used for retained laryngeal phonation. It is a proper and practical surgical therapy for laryngeal cancer and should be widely applied.