扩大垂直半喉切除术和环状软骨舌骨会厌吻合术疗效观察和术后评估

Comparing extended vertical partial laryngectomy and cricohyoidoepiglottopexy in the treatment of laryngeal carcinoma

目的扩大垂直半喉切除和传统喉环状软骨上部分切除环舌骨会厌吻合术（cricochyoidoepigl0110pexy，CHEP）的疗效和术后评估的比较。方法回顾性分析1998--2005年扩大垂直半喉切除患者和传统喉环状软骨上部分切除环舌骨会厌吻合术式患者临床资料。扩大垂直半喉切除方法为：按类似扩大垂直半喉术式的方法切除健侧声带、室带及1／3至2／3左右的甲状软骨板，保留健侧环杓关节，切除患侧声带、室带、患侧活动受限或固定的杓状软骨及患侧2／3左右甲状软骨板，保留双侧甲状软骨板的后缘，直接将环状软骨上提和舌骨会厌固定吻合。扩大垂直半喉切除组（简称改良组）：37例声门型喉癌，1、216例，1、321例。传统CHEP组：34例声门型喉癌，T212例，r1321例，T41例。结果Kaplan—Meier法统计生存率，改良组的3年累积生存率为91．7％，传统CHEP组为87．5％，差异无统计学意义（P〉0．05）。改良组的5年累积生存率为80．6％，传统CHEP组为81．3％，差异无统计学意义（P〉0．05）。术后拔管率改良组为100．0％（37／37），传统CHEP组为94．1％（32／34），两组差异无统计学意义（P〉0．05）。术后拔管平均时间（露±s）改良组为（14．0±2．3）d，传统CHEP组为（19．0±4．6）d，两组差异有统计学意义（t：5．80，P〈0．001）。术后8周评价误咽发生率，改良组为2．7％（1／37），传统CHEP组为23．5％（8／34），两组差异有统计学意义（P〈0．05）；术后误咽呛咳评分通过Ridit分析，结果表明两组之间差异有统计学意义（U=7．341，P〈0．001），改良组误咽呛咳的不适症状明显轻于传统CHEP组。结论扩大垂直半喉切除在肿瘤根治上和传统CHEP术式无差别，而在喉功能保全上优于传统CHEP术式。

Objective To compare the results of extended vertical partial laryngectomy （ similar to modified supracricoid partial laryngeetomy with crieohyoidoepiglottopexy） and erieohyoidoepiglottopexy in the treatment of laryngeal carcinoma. Methods Retrospectively analyzed on the results and prognosis in patients underwent extended vertical partial laryngectomy and cricohyoidoepiglottopexy between 1998 and 2005. The operation was similar to extended vertical partial laryngeetom. The healthy vocal cord and ventricular band as well as about 1/3 to 2/3 laminas of thyoid cartilage were removed. The healthy erieoarytenoid joint was reserved. The vocal cord, ventricular band, fixed or limitation of motion arytenoid cartilage and 2/3 laminas of thyoid cartilage in ill side were removed. The posteroinferior border of laminas of thyoid cartilage in both sides were reserved. The cricoid was lifted and fixed with hyoid epiglottis directly. Extended vertical partial laryngectomy group consisted of 37 patients with glottie carcinoma （ stage T2 16 eases, stage T3 21 cases） and cricohyoidoepiglottopexy group consisted of 34 patients with glottie carcinoma （stage T2 12 cases, stage T3 21 cases, stage T4 1 ease）. Results Kaplan-Meier analysis was performed to calculate the survival rates. The three-year cumulative survival rate was 91.7% in extended vertical partial laryngectomy group and 87.5% in crieohyoidoepiglottopexy group respectively. There was no significant difference between the two groups （ P 〉 0.05 ） . The five-year cumulative survival rate was 80. 6% in extended vertical partial laryngectomy group and 81.3% in cricohyoidoepiglottopexy group respectively.There was also no significant difference between the two groups （ P 〉 O. 05 ）. The decannulation rate was 100% （37/37） in extended vertical partial laryngectomy group and 94. 1% （32/34） in cricohyoidoepiglottopexy group respectively. The decannulation time was （ 14. 0 ＋ 2. 3 ） days in extended vertical partial laryngectomy group and （ 19. 0 ＋ 4. 6 ） days in cricohyoidoepiglottopexy group respectively. The incidence of aspiration was 2.7% （1/37） in modified group and 23.5 （8/34） in cricohyoidoepiglottopexy group respectively evaluated at 8th weeks post-operatively. The evaluation of deglutition disorder was analyzed by Ridit analysis in both groups and the results showed that there was significant difference between the two groups （ U = 7. 341, P 〈 0. 001 ）. The symptom of aspiration in extended vertical partial laryngectomy group was significant less than in cricohyoidoepiglottopexy group. Conclusions Although the survival rate was not different between the two groups. The preservation of laryngeal function in extended vertical partial laryngeetomy group was significant better than in cricohyoidoepiglottopexy group and extended vertical partial laryngeetomy.