显微声带撕皮和黏膜缝合治疗早期喉癌

Microsurgical laryngofissure for early laryngeal cancer

目的:观察用显微声带撕皮和黏膜缝合法治疗早期喉癌的初步效果。方法:2000年1月至2003年5月行8例手术,随访24-54个月,平均28个月,男6例,女2例。48-78岁,平均67岁。5例术前活检为声带鳞癌,2例声带重度不典型增生(术后标本为鳞癌),1例手术前后均为重度不典型增生。手术在全麻下行气管切开喉裂开术,显微镜下辨认病灶边缘。黏膜下浸润麻醉以使局部水肿,用微型钳提起肿瘤周边黏膜,在黏膜下分离疏松组织,完整切下肿瘤。周边黏膜下稍作分离,用可吸收线间断缝合,复盖好可能暴露的杓状软骨角。2例术后组织标本示癌浸润范围较大行放疗。每月随访1次,内窥镜摄照,半年后3月随访1次,2年后6个月随访1次,无失访者。结果:患者均无瘤生存,6例有复发征象,发声有改善。1例2年后术侧无复发,而对侧声带出现肿瘤,间接喉镜下病理证实为癌,后在显微支撑喉镜下行激光切除,又随访半年以上未再见有病变;另1例原重度不典型增生,术后2年患侧前联合处出现息肉样生长,显微喉镜下病理报告为I级鳞癌,行激光手术,随访半年。结论:显微撕皮法治疗早期喉癌疗效肯定,功能恢复好,值得进一步研究。

Objective： To observe and analyze the effect of microsurgical laryngofissure for early laryngeal cancer. Methods： Six male and 2 female patients, aged from 48 to 78 years, were operated on and followed up for a mean of 28 months （ranged from 24 to 54 months）. Five patients were diagnosed as having degree I lottis cancer by biopsy before operation, 2 atypical hyperplasia before operation but as degree I cancer after operation, and 1 atypical hyperplasia both before and after operation. After laryngofissure, the cancer focus was completely cut from glottis and drawn under microscope. Two cases were given irradiation after operation. Results ： Eight cases were all alive, and 6 had no recurrence. One had a recurrent focus in the opposite vocal cord, and 1 of atypical hyperplasia had a cancer focus two years after operation. Both the two were reoperated on surgical laryngofissure for early laryng by laser and were still alive over half a year after reoperation. Conclusion： Microeal cancer can preserve patients＇ phonate and increase their living quality.