喉垂直切除会厌下移喉重建术治疗早期声带癌的疗效观察

Partial vertical laryngectomy with epiglottis reconstruction-Tucker technique

目的:评价喉垂直切除会厌下移喉重建术(Tucker技术)治疗早期声带癌(T1b,T2)的效果,明确Tucker技术的手术适应证。方法:回顾性分析139例接受Tucker技术治疗患者的临床资料,其中127例是首次接受治疗的患者(T1b48例,T279例),12例(Tr)是声带癌曾接受过放射治疗或声带切除后复发的患者。计算生存率和评估喉功能恢复情况。结果:T1期患者的5年生存率为91.0%,肿瘤局部控制率为100%;T2期患者的5年生存率为86%,肿瘤局部控制率为94.0%;Tr期患者的5年生存率为64.0%,肿瘤局部控制率为82%。喉功能保留方面:气管拔管率为100%,平均拔管时间10d。胃管拔除率为99.3%(138/139),6例因误咽施行了胃造漏术,1例因顽固性误咽导致吸入性肺炎施行了功能性全喉切除术;平均胃管拔管时间为15d。121例(87.1%)患者获得了好或较好的发声,18例患者的发声质量较差如同耳语声。结论:喉垂直切除会厌下移喉重建术(Tucker技术)是治疗T和T期声带癌的有效手术方法。

Objective:To evaluate the results of partial supracricoid laryngectomy with Tucker′s reconstruction in T_ 1b and T_2 stages of glottic laryngocarcinoma.Method:One hundred and thirty-nine patients received partial supracricoid laryngectomy with Tucker′s reconstruction were analyzed,among them,127 patients (T_ 1b -48,T_2-79) had never been treated,12 patients with glottic cancer (Tr) recurred after radiotherapy or cordectomy. We calculate survival rate and evaluate the function of larynx according to the stage. Result:For carcinology: 5-years survival rate for T_1, T_2 and Tr stages was 91%,86% and 64% respectively;5-years local control rate for T_1,T_2 and Tr stages was 100%,94% and 82% respectively. With respect to the laryngeal function, the rate of decanalation is 100%, the average duration of decanalition is 10 days.The rate of the oblation of the naso-gastric tube is 99.3% .Six patients had accepted gastrotomy with difficulty during the deglutition of liquids;1 patient had to have total laryngectomy because of incurable disorder of the deglutition.The time of the ablation of the naso-gastric tube is 15 days on average.One hundred and twenty-one patients (87%) presentented a satisfactory voice and only 18 patients have a medium voice quality.Conclusion:Tucker technique is a reliable intervention on the carcinology and laryngeal function for the glottic lesions of T_ 1b and T_2.