559例喉癌喉部分切除术的远期疗效观察

Long-term follow-up study of 559 cases with laryngeal carcinoma

目的观察喉部分切除术的远期疗效及喉功能的恢复情况。方法总结中国医科大学第一附属医院耳鼻咽喉科1996至2002年各种喉部分切除术559例，其中男435例，女124例。按2002年UICC标准，声门上癌200例（Ⅰ期15例，Ⅱ期81例，Ⅲ期72例，Ⅳ期32例）；声门癌354例（Ⅰ期141例，Ⅱ期124例，Ⅲ期88例，Ⅳ期1例）；跨声门癌5例（Ⅱ期2例，Ⅲ期3例）。在彻底切除病变的基础上，尽量保留喉的正常组织和部分功能为术式选择的依据，安全缘≥5mm。其中声带切除术66例，垂直部分切除术119例，声门上水平部分切除术62例，水平垂直（3／4）部分切除术113例，喉次全切除环舌根会厌吻合术88例，喉近全切除环舌根吻合术（保留一侧杓状软骨）26例，喉癌激光切除术85例。同期行颈清扫术261例（单侧174例、双侧87例）。安全缘≤5mm或淋巴转移怀疑有残留时术后放疗。结果全部病例恢复发音功能。术后采用鼻饲管474例，7～24d全部克服误咽拔掉鼻饲管；466例（98．3％）在术后9d～3个月拔除气管套管。本组患者3、5、10年随访率分别为99．6％（557／559）、98．2％（549／559）、95．8％（183／191），直接法统计生存率，失访以死亡计。3年生存率为89．6％（501／559），其中声门上型Ⅰ＋Ⅱ期生存率为90．6％，Ⅲ＋Ⅳ期生存率为81．7％；声门型Ⅰ＋Ⅱ期生存率为95．2％，m＋Ⅳ期生存率为82．4％。5年生存率为75．0％（419／559），其中声门上型Ⅰ＋Ⅱ期生存率为75．0％，Ⅲ＋Ⅳ期生存率为62．5％；声门型Ⅰ＋Ⅱ期生存率为81．8％，Ⅲ＋Ⅳ期生存率为70．6％。10年生存率71．2％（136／191），其中声门上型Ⅰ＋Ⅱ期生存率为69．7％，Ⅲ＋Ⅳ期生存率为65．2％，声门型Ⅰ＋Ⅱ期生存率为77．6％，Ⅲ＋Ⅳ期生存率为72．1％。结论正确选择术式、手术切除范围和颈清扫方式以及适当的放疗可在保证喉癌部分切除术生存率的同时促进喉功能的恢复。

Objective To study the long-term follow-up result of partial laryugectomy and reservation of laryngeal function. Methods Five hundred and fifty-nine patients who underwent partial laryngectomy from 1996 to 2002 were summarized （male 435 eases, female 124 eases）. Among them, 200 eases were supraglottie carcinomas （ classified accordingly by UICC standard of years 2002 into： 15 cases of Ⅰ , 81 cases of Ⅱ , 72 cases ofⅢ, and 32 cases of Ⅳ ） , 354 cases were glottic carcinomas （ 141 cases of Ⅰ , 124 cases of Ⅱ , 88 cases of Ⅲ, and 1 cases of Ⅳ） , 5 cases were transglottic carcinomas （2 cases of Ⅱ and 3 cases of Ⅲ ）. In common 7 kinds of operations were performed：66 cases underwent cordectomy, 119 vertical laryngectomy, 62 horizontal supraglottic laryngectomy, 113 horizontovertical （3/4） laryngectomy, 88 subtotal laryngectomy with cricoglossoepiglottic anastomosis,26 neartotal laryngectomy with cricoglossal anastomosis （ with reservation of unilateral arytenoid cartilage ） , 85 laser laryngectomy. Two hundred and sixty-one cases underwent concurrent neck dissection （174 unilateral, 87 bilateral ）. Safety margin of less than or equal to 5 mm was suspected of having residual lymph node metastasis, the postoperative radiation therapy to treatment. Results All cases restored their phonation and overcame aspiration with removing nasal feeding from 7 to 24 days after operations. Four hundred and sixty-six cases were decannulated from 9 days to 3 months after operations. Decannulation rate was 98.3%. Through periodic review of out-patient clinics or telephone follow-up, family members follow-up a variety of ways, three, five or ten years follow-up rate： 99. 6% （557/559）, 98.2% （549/559）, 95.8% （ 183/191 ）, dollars lost to death. The three years survival rates were 89. 6% （501/559）. Among them, the survival rates for supraglottic carcinoma patients of stage Ⅰ and Ⅱ was 90. 6% , stage Ⅲ and Ⅳ 81.7% , for glottic carcinoma patient of stage Ⅰand Ⅱ was 95.2%, stage Ⅲ and Ⅳ 82. 4%. The five years survival rates were 75.0% （419/559）. Among them, the survival rates for supraglottic carcinoma patients of stage Ⅰand Ⅱ was 75.0% , stage Ⅲ and Ⅳ 62. 5% , for glottic carcinoma patient of stage Ⅰ and Ⅱ was 81.8% , stage Ⅲand Ⅳ70. 6%. The ten year survival rates were 71.2% （136/191）. Among them, the survival rates for supraglottic carcinoma patients of stage Ⅰ and Ⅱwas 69.7% , stage Ⅲ and Ⅳ 65. 2% , for glottie carcinoma patient of stage Ⅰ and Ⅱ was 77.6%, stage Ⅲ and Ⅳ 72. 1%. Conclusions Partial laryngectomy is a kind of radical operation with reservation of laryngeal function. Qualities of life and curative effect, were greatly improved.