喉癌手术120例临床分析

A Review of 120 Cases with Laryngectomy for Laryngeal Carcinoma

目的：对120例喉部分切除、喉功能重建的喉癌患者的临床资料进行回顾性分析,并对各种术式和修复方法的疗效进行评价。方法：对120例喉癌患者行喉部分切除术,同期采用颈前带状肌肌筋膜瓣、会厌瓣加双蒂肌筋膜瓣和舌骨肌瓣修复喉组织缺损,重建喉功能。36例颈淋巴结转移者同期行颈廓清术。结果：所有患者于术后10~15 d开始进食;术后拔除气管套管率74.17%;21例发生术后感染,5例发生咽瘘;3年、5年生存率分别为75.00%和67.50%;有颈淋巴结转移者生存率低于无转移者,未接受放疗者生存率低于术后放疗者,差异均有统计学意义（P〈0.05）。结论：依据喉癌发生的部位和累及范围选择不同的术式和修复方法,可提高同期喉功能重建成功率,提高患者的生活质量。

Objective：To assess the efficacy of the laryngectomy for laryngeal carcinoma.Methods：120 cases of laryngeal carcinoma were treated in this department from 1995 to 2003.The laryngeal defects after partial laryngectomy were reconstructed with bi-pedicle muscle flap,epiglottic flap plus bi-pedicle muscle flap,or hyoid osteo-muscular flap.Among them,neck dissection was performed in 36 patients with cervical lymph node metastases.Results：All the cases began to take food through mouth 10 to 15 days after operation.The decannulation rate was 74.17%.The wound infection occurred in 21 cases,and pharyngo-cutaneous fistulae in 5 cases.The 3 and 5 year survival rates were 75.00% and 67.50% respectively.The survival rates of patients with cervical lymph nodes metastases were lower than those without lymph nodes metastases;the survival rates of patients with postoperative radiotherapy were higher than those without postoperative radiotherapy（P0.05）.Conclusion：The procedures of partial laryngectomy and reconstruction should be chosen according to the location of laryngeal carcinoma and extension involved.The corresponding reconstruction of laryngeal functions can improve the survival rate and quality of life of the patients.