喉大部分切除——Pearson言语重建手术34例报告

Near-total laryngectomy and speech rehabilitation in treatment of advanced laryngeal and hypopharyngeal carcinoma

目的总结分析34例中晚期喉癌及下咽癌的Pearson发音重建手术经验。方法34例喉鳞癌及下咽癌病人中,喉癌外侵梨状窝12例,梨状窝癌侵犯喉22例。根据UICC与AJCC2002统一的TNM分类标准喉癌T3N03例,T3N12例,T4N02例,T4N15例;下咽癌T3N08例,T3N13例;T4N05例,T4N16例。所有病人均采用喉大部分切除—Pearson发音重建,且在同期行颈廓清术。术后放疗25例,剂量55～65Gy。结果术后发音成功者29例,占85.3%(29/34);术后声音小、音时短者2例;黏膜管闭塞且无法发音者3例。进食无呛咳、术后20d内拔除鼻饲管者25例,1～3个月后拔鼻饲管者8例,重度误吸1例(保留鼻饲管达1年);咽瘘3例。随访3年以上,淋巴结再转移率35.3%(12/34);术后残喉复发2例,3年残喉复发率5.9%(2/34)。死亡10例,3年生存率70.6%(24/34)。结论喉大部分切除加发音重建,黏膜管内径4～5mm比较适合,无误吸,发音好。

Objective To stmmerise and analyse the experience of near-total laryngectomy and speech rehabilitation in the treatment of advanced laryngeal and hypopharyngeal carcinoma from 1997 to 2000. Methods Thirty-four males patients were treated with near-total laryngectomy, speech rehabilitation and neck dissection. Twenty-five cases underwent radiotherapy （total dosage： 55-65 Gy） after the surgery. The classification of these carcinoma was as the following, laryngeal carcinoma： T3N0 3 cases, T3N1 2 cases, T4N0 2 cases, and T4N1 5 cases; hypopharyngeal carcinoma： T3N0 8 cases, T3N1 3 cases, T4N0 5 cases, and T4N1 6 cases （according to UICC 2002 TNM standard）. Results The speech function was obtained in 29 patients （29/34, 85.3 % ） and good swallow function was obtained in 33 patients （33/34, 97.1% ） ; 3-year survival rate was 70.6%. Conclusion if the inner diameter of the mucosa tube is as large as 4-5 mm for near-total laryngectomy in advanced laryngeal and hypopharyngeal carcinoma patients, the good speech and swallow function rehabilitation can be got after surgery.