声门上和声门区同时受累的喉癌患者保留会厌手术的研究

摘要

目的：探究保留会厌的声门上和声门区同时受累喉癌患者的手术方法及治疗效果。方法对90例会厌正常而声门上、声门区同时受累的喉癌患者进行回顾性分析，其中10例行环舌骨会厌固定手术（ CHEP组），80例行扩大喉垂直部分切除手术与喉垂直部分切除手术（ EVPL与VPL组），对比2组术后嗓音、嗓音相关生活质量、喉功能以及生存情况。结果2组患者在3年、5年的生存率、复发率、拔管率以及嗓音障碍指数等方面对比，差异不存在统计学意义（P＞0．05），但EVPL与VPL组的平均恢复进食时间、最长声时、清／浊音比（S／Z）、总嘶哑度及气息声等，均显著优于CHEP组，差异存在统计学意义（P＜0．05）。结论对于保留会厌的声门上和声门区同时受累喉癌患者，扩大喉垂直部分切除手术与喉垂直部分切除手术，更符合生理解剖状态，有利于术后功能与嗓音质量恢复、生活质量的提升。%Objective To investigate the surgical method and therapeutic effects of epiglottis-preserving surgery for la-ryngeal cancer involving supraglottic and glottis area .Methods 90 cases with laryngeal cancer involving both supraglottic and glottis areas with normal epiglottis were analyzed retrospectively .10 cases were treated by cricohyoidoepiglottopexy ( CHEP ) (CHEP group),while expanded vertical partial laryngectomy (EVPL)and vertical partial laryngectomy (VPL) were carried out in 80 cases(EVPL and VPL group),and the voice,the voice-related quality of life,laryngeal function and survival of the 2 groups were compared.Results The difference in 3-,5-year survival rates,recurrence rate,decannulation rate and the index of voice disorders between the 2 groups was not statistically significant (P>0.05),but the average oral diet recovery time ,the S/Z ratio ( S/Z) ,total and breath voice hoarse of the EVPL and VPL group ,were significantly better than the those of the CHEP group ,the difference was statistically significant(P<0.05).Conclusion For epiglottis-preserving laryngeal carcinoma involving supraglot-tic and glottis areas ,EVPL and VPL is more aligned with physiological anatomy state ,and it is good for the recovery of function and voice quality ,and improvement of the quality of life .