声门下癌的临床及其手术治疗

Surgical management of subglottic carcinoma

目的 探讨声门下癌的临床特点、手术和重建喉功能的方法及喉声门下部分切除术的可行性。方法 总结 1981～ 1997年声门下癌 13例 ,T1 2 N0 6例 ,T3N0 1例 ,T3 4N1 2 6例。 4例行全喉切除术 ,9例行喉声门下部分切除术和扩大喉声门下部分切除术 (累及气管者 ) ,分别以单侧或双侧皮瓣、肌筋膜瓣整复 ,喉腔内置“T”型硅胶管扩张 ,2～ 6个月拔除。其中 6例行颈清扫术。结果 除 4例全喉切除术者外 ,余 9例均恢复发音功能。 5例拔除气管套管 ,占 5 5 6% ,全部恢复吞咽功能。全喉切除和喉声门下部分切除术的 3、5年存活率分别为 10 0 %、66 7%和 88 9%、75 0 %。结论 对 4 0岁以上的男性声嘶患者应常规行纤维喉镜和动态喉镜检查 ,结合CT、MRI等 ,早期诊断是可能的。对大部分患者仍可行喉声门下部分切除术或扩大切除术。并提出对T3、T4者应酌情行颈清扫术。术后预防性放射治疗是必要的。

Objective To explore the clinical features and the methods of surgery and functional restoration of subglottic carcinoma Methods Thirteen cases with primary subglottic carcinoma were treated surgically in this department from 1981 to 1997 Among them, six had T 1 2 N 0 lesions, one had T 3N 0 lesion and six had T 3 4 N 1 2 lesions Four cases underwent total laryngectomy and nine had subglottic partial laryngectomy The extensive subglottic partial laryngectomy was performed on patients with tracheal invasion The defects of larynx were reconstructed by using unilateral or bilateral pedicled musculocutaneous flap, myofascial flap accordingly T shape silastic tube was placed in to the reconstructed cavity of larynx during the operation and the patients were decannulated in 2 to 6 months Unilateral radical neck dissection was performed on 4 patients and bilateral on 2 Results All cases had restored the function of phonation except for 4 who underwent total laryngectomy Five out of 9 (55 6%) were decannulated The swallowing function was restored in all patients The 3 year and 5 year survival rates were 100% and 66 7% in the cases with total laryngectomy, 88 9% and 75 0% with subglottic partial laryngectomy, respectively Conclusion It is possible to detect early subglottic carcinoma by using fiberoptic laryngoscopy routinely with the combination of stroboscopy, CT, MRI in male patients over 40 with hoarseness It is practical that the whole or partial function of larynx could be restored in most cases with subglottic carcinoma after partial laryngectomy or subtotal laryngectomy Unilateral or bilateral neck dissection should be performed on patients with T 3 or T 4 lesion Postoperative radiotherapy is necessary