近似全喉切除治疗喉癌疗效分析

Near total laryngectomy in the treatment for advanced laryngeal cancer:Oncologic and rehabilitative result

自Ｐｅａｒｓｏｎ（１９８０）提出近似全喉切除术（ｎｅａｒｔｏｔａｌｌａｒｙｎｇｅｃｔｏｍｙ，ＮＴＬ）后，患者虽不能用鼻呼吸，却可发出嗓音，显著改善患者术后生存质量。本文回顾分析福州市两个医院１９８０～１９９２年间对９６例喉癌患者施行ＮＴＬ的经验，介绍了该术式的适应证、手术径路和方法，分析治愈率和并发症。本组９６例中，术后３～４周仅７例无声，８９例（９２．７％）术后能连续大声说话；术后早期（１～３周）３４．４％（３３ｌ９６）虽有轻度误吸，均能在４～６周后恢复；１８．８％（１８／９６）病例气管造口狭窄，经Ｚ形模扩张而拔管。７３例随访时间５年以上，术后５年生存率和５年无癌生存率分别为７９．５％（５８／７３）和７１．２％（５２／７３）。

Abstract Near total laryngectomy ( NTL)introduced by Pearson(1980)is a medification and com-promise between the total laryngectomy and partial laryngectomy, Although it cannot be reconsti-tuted to allow breathing,can readily be used for articulation. Ninty-six patients(93 males,3 fe-mals,ranging in age from 21 to 83 years)of NTL for laryngeal cancer over 12 years(1980～1992)were analysed to determine the oncologic and rehabilitation results; Vocal restoration with-out prothesis was archieved in 72.7%, Minor aspiration occurs early in 34.4%, but perfect re-covery was possible in this group. Eighteen cases(18.8%,18/96)requires a second Z-plasty procedure before a patent trachostoma was archieved.Five-year survial rate was 7 9.5%.