205例喉癌的手术方式与远期疗效分析

Surgery on laryngeal carcinoma——retrospective analysis of 205 cases

目的分析1990年以来喉癌手术治疗的方法及其远期疗效,以改进治疗并提高生存率。方法对1990年1月—2004年10月间手术治疗的205例病例进行临床随访、病历资料分析。其中声门上型52例,声门型149例,声门下型4例;按UICC1997年分期标准Ⅰ期48例,Ⅱ期88例,Ⅲ期44例,Ⅳ期25例。行支撑喉镜下声带切除术1例,撕皮术2例,喉裂开声带切除术9例,未行气管切开的喉垂直部分切除术16例,喉垂直部分切除术25例,水平半喉切除术7例,Arslan(咽气管吻合)手术15例,环舌骨会厌固定术(cricohyoidoepiglottopexy,CHEP)57例,喉次全切除术16例,喉全切除术57例。结果205例仅4例失访,Kaplan-Meier法统计总的1年生存率96.0%,3年生存率84.8%,5年生存率为79.4%,其中声门上型1年生存率88.3%,3年为67.5%,5年为65.0%;声门型1年生存率99.3%,3年为91.3%,5年为84.7%,喉功能保存率72.7%。早期肿瘤(Ⅰ、Ⅱ期)与晚期肿瘤(Ⅲ、Ⅳ期)患者之间生存率差异有统计学意义(P<0.01),肿瘤不同发病部位(声门型、声门上型)患者之间生存率差异有统计学意义(P<0.05)。结论喉癌手术治疗效果好,喉功能保存率高,其预后与肿瘤分期、发病部位有关。提倡严格掌握手术指征,在保证手术安全边缘的情况下,制定个体化治疗方案,运用最优的手术切除和功能重建方法,综合治疗,提高生存质量。

Objective To evaluate the results of surgery for laryngeal carcinoma. Methods A retrospective analysis of long-term therapeutic effect was made on surgery of 105 patients with laryngeal carcinoma in the past 15 years. There were 197 males, 8 cases of female. Tumor stage were included 3 cases of Tis NOM0, 45 cases of T1NOM0, 1 case of T1 N1M0, 88 cases of T2NOM0,3 cases of T2N1M0,1 case of T2N2M0,33 cases of T3NOM0,7 cases of T3N1M0,3 cases of T3N2M0,13 cases of T4NOM0,6 cases of T4N1M0,1 case of T4N2M0 and 1 case of T4N3M0. Different kinds of operations were as follows：cordectomy（ 1 case） or stripping （2 cases） by suspended laryngoscope, laryngofissure （9 cases）, vertical partial laryngectomy without tracheotomy（ 16 cases）, vertical partial laryngectomy （25 cases）, horizontal laryngectomy （ 7 cases ） , Arslan＇ s procedure （ 15 cases ）, cricohyoidoepiglottopexy （ 57 cases ） , subtotal laryngectomy（ 16 cases） andtotal laryngectomy （57 cases）. Results There were only four missing cases among all 205 cases. The 3- and 5-year survival rate for glottandcarcinoma is 91.3% and 84. 7% respectively. The 3- and 5-year survival rate for supraglottic carcinoma is 67.5% and 65.0% respectively.Statistical differences were noted between survival rate of glottic and supraglottic carcinoma and between early and advantage disease. The overall 3- and 5-year survival rate is 84.8% and 79. 4% respectively. The rate of surgical preservation of laryngeal function is 72. 7%. Conclusions The prognosis factors of laryngeal cancer were tumor stage, subsite , neck metastasis. All patients treated with different surgical techniques had fairly good quality of functional results. It is possible to preserve the laryngeal function by proper indication, safe margin, combined radiotherapy without compromising survival.