喉近全切除术的扩大适应证

The extended indications of near total laryngectomy

目的进一步总结喉近全切除术的经验。方法选择Ｔ３、Ｔ４喉鳞状细胞癌５７例行喉近全切除术。结果术后发音成功率９３％，３年生存率为６７．５％，下咽癌为５０％，局部复发率仅３．５％。其适应征为不适宜常规部分喉切除的喉癌；还可应用于舌根口咽癌、梨状窝癌、颈段食管癌等。结论只要适应证选择得当，喉近全切除术是一种手术方法不过繁、安全、减少无喉残废的方法。

Objective To evaluate near total laryngectomy in treatment of laryngeal cancers. Methods Fifty seven near total laryngectomies were reviewed, among them 40 were T 3 or T 4 laryngeal cancers due to tumor invasion to the base of tongue or subglottic region. Results In these patients, there were 11 cases of T 3 pyriform sinus cancers, 5 cervical esophageal cancers, 1 case with adenoid cystic carcinoma involving the base of the tongue and oropharynx. Speech function had been preserved in 93% of cases with normal swallowing. Three year survival rates were 67.5% in laryngeal cancer and 50% in hypopharyngeal cancer. Local recurrence rate was only 3.5%. Conclusion The authors believed that near total laryngectomy is safe and beneficial to the patients with the above types of cancers. The quality of life may improve if speech function is preserved.