环状软骨上喉部分切除术的探讨

Supracricoid partial laryngectomy for laryngeal cancer

目的 通过对 18例喉癌患者的手术治疗 ,就环状软骨上喉部分切除术的有关问题进行探讨。方法 声门癌T1N0 M0 1例 ,T2 N0 M0 9例 ,T3N0 M0 2例 ,跨声门癌T3N1M0 3例 ,T3N2 M0 1例 ,T2 N0 M0 放射治疗后复发 1例 ,声门下癌T4N0 M0 1例 ;应用三种不同的环状软骨上喉部分切除术技术进行治疗。结果 3年生存率 94 .4 %。所有患者均于术后第 7～ 4 2天 (平均 17天 )拔除气管套管 ,拔管率 10 0 % ;所有患者均在术后第 14～ 3 0天 (平均 2 2天 )拔除鼻饲管。术后所有患者均完全恢复了喉的发声、呼吸、吞咽及维持声门下压的生理功能。术后的发音情况也令人满意。结论 环状软骨上喉部分切除术打破了以往根据喉癌肿瘤临床分期决定喉部分切除与否的传统观点 ,为喉癌的手术治疗提出了一条新的术式。它在保证完整、安全有效地切除喉肿瘤病灶的同时 ,更加考虑到患者术后的功能及生存质量的改善 ,同时又能达到喉全切除术同样的局部控制率 。

Objective To analyze the key points, especially the indications and contraindications of supracricoid partial laryngectomy (SCPL). Methods During the years 1995 to 1996, 18 patients with laryngeal cancer underwent supracricoid partial laryngectomy. Ten of them (55.56% ) were classified as T 1b and T 2 glottic cancers, 8 of them (44.44%) as T 3 and T 4 glottic cancer or transglottic carcinomas. Three types of supracricoid partial laryngectomy (CHP, CHEP and TCHEP) were employed accordingly. Results Overall three year survival rate was 94.40%. All patients were decannulated from 14 to 42 days and all resumed normal oral feeding from 14 to 30 days. Speech was good in all patients. Conclution The SCPL procedure not only increases local control rate, but also maintains physiologic speech and swallowing.