环状软骨上喉次全切除术治疗声门型喉癌

Treatment of Glottic Cancer with Supracricoid Partial Laryngectomy

目的总结环状软骨上喉次全切除术用于治疗声门型喉癌的疗效以及术后喉功能的恢复情况。方法声门型喉鳞癌21例,均行环状软骨上喉次全切除术加上双侧Ⅱ、Ⅲ、Ⅳ组淋巴结清除术或一侧Ⅱ、Ⅲ、Ⅳ组淋巴结清除术加上病变较轻侧Ⅱ、Ⅲ组淋巴结清除,19例行环状软骨舌骨会厌固定术,2例行环状软骨舌骨固定术;4例T4及2例T3N1病例术前以泰素＋顺铂（TP）方案化疗一个周期,7例T4及N1的病例术后放疗50 Gy。结果所有病例随访1～3年均未见肿瘤复发,20例存在不同程度的误咽;吞咽功能训练时间7～50 d;其中1例CHP患者训练1月后出现吸入性肺炎,停止训练,经抗炎治疗,继续训练后完全恢复吞咽功能;另1例CHP患者训练3周后恢复吞咽功能。所有病例术后均成功拔管,拔管率100%;发音功能良好、中等、差者分别为2、16、3例。结论环状软骨上喉次全切除术是一种操作简便、并发症少、既能保证肿瘤根治又能较好地保全喉功能的有效术式。

Objective To investigate the curative effect and laryngeal functional recovery of the glottic cancer patients by supracricoid partial laryngectomy. Methods 21 cases of glottic cancer accepted supraericoid partial laryngectomy with bilateral select neck dissection of region Ⅱ、Ⅲ、Ⅳ, or a dissection of region of Ⅱ、Ⅲ、Ⅳ in affected side and Ⅱ、Ⅲ in contra lateral. 19 cases accepted cricohyoidoepiglottopexy （CHEP）, 2 accepted cricohyoidopexy （CHP） also. 4 cases of T4 and 2 of T3N1 accepted a cycle preoperative chemotherapy, the chemotherapy regimens consisted of taxol and cisplatin （TP）. 7 cases of T4 and N1 accepted 50 Gy postoperative radiotherapy. Results All these cases were followed up 1 to 3 years, and no recurrence were found. Except one case, all have deglutition disorders at different degree. Deglutition training lasted from 7 to 50 days. One patient following CHP suspended for aspiration pneumonia after training a month; and fully recovered after anti-inflammation therapy for a week, and then kept on trainimn for 2 weeks. All the tracheotomy tube can be removed successfully after operation in these cases. Phonetic function recovered well in 2 cases, median in 16 cases, and poorly 3 cases. Conclusions Supracricoid partial laryngectomy is an effective operating type of ensuring oncological resection and conserving laryngeal function well, and with easy manipulation and less complications.