不同手术方案的喉癌患者喉环状软骨上部分切除术后发生误咽的比较

Comparison of postoperative deglutition disorder in patients with laryngeal carcinoma after different types of supracricoid partial laryngectomy

目的 比较采用不同手术方案治疗的喉癌患者喉环状软骨上部分切除术后误咽发生情况及其程度.方法 回顾性分析67例喉癌患者行喉环状软骨上部分切除术后误咽的发生情况,其中行喉环状软骨上部分切除环舌骨会厌吻合术（SCPL-CHEP）37例,喉环状软骨上部分切除环舌骨吻合术（SCPL-CHP）30例,并采用自制的量化的术后误咽程度评分表对术后5～20 d患者进行误咽程度评估.结果 SCPL-CHEP组术后误咽程度评分为（2.71±0.31）分,SCPL-CHP组为（3.43±0.64）分,两组术后误咽程度评分差异有统计学意义（P〈0.001）.Pearson相关分析显示,年龄是喉环状软骨上部分切除患者出现术后误咽的一个重要因素,SCPL-CHEP组术后误咽程度评分与患者年龄的相关系数为0.947（P〈0.0001）,SCPL-CHP组为0.907（P〈0.0001）.SCPL-CHEP组和SCPL-CHP组术后8周误咽发生率分别为2.7%（1/37）和23.3%（7/30）,两组差异有统计学意义（P=0.012）.结论 不同手术方案是喉环状软骨上部分切除患者出现术后误咽的一个重要因素,其中SCPL-CHP后患者误咽发生程度严重,且术后误咽的严重程度随着患者年龄的增加而明显加重,对高龄（〉70岁）喉癌患者手术方式的选择应谨慎,特别是SCPL-CHP术式.

Objective To Evaluate the incidence rates and extents of deglutition disorder in patients with laryngeal carcinoma after different types of supracricoid partial laryngectomy.Methods Retrospective analysis of postoperative deglutition disorder in patients with laryngeal carcinoma after different types of supracricoid partial laryngectomy treated in our department from 2005 to 2009.The extents of postoperative deglutition disorder were evaluated using a homemade quantitative score table at 5-20 days postoperation.Results The score of deglutition disorder was 2.71 ± 0.31 in the supracricoid partial laryngectomycricohyoidoepiglottopexy （ SCPL-CHEP ） operation group and 3.43 ± 0.64 in the supracricoid partial laryngectomy-cricohyoidopexy （SCPL-CHP） group, respectively.The deference was statistically significant between the two groups （ P 〈 0.001 ）.The coefficient between age and score of postoperative deglutition disorder was assessed by Pearson correlation analysis.The coefficient of correlation was 0.947 （P 〈 0.0001 ）in the SCPL-CHEP group and 0.907（ P 〈0.0001 ） in the SCPL-CHP group.The incidence rate of deglutition disorder was 1/37 in the SCPL-CHEP group and 7/30 in the SCPL-CHP group, evaluated at 8 weeks postoperation （P = 0.012）.The deference between the two groups was significant.Conclusions The type of operation procedure is an important factor affecting the occurrence of postoperative deglutition disorder in the patients after supracricoid partial laryngectomy, more serious in the SCPL-CHP group.The severity of postoperative deglutition disorder is more serious along with the increase of patient＇s age.For the elderly （ 〉70 years of age） patients with laryngeal carcinoma, the choice of surgical procedure should be more cautious, especially with the SCPL-CHP operation.