环状软骨舌骨吻合术和喉水平垂直部分切除术治疗中晚期喉癌术后嗓音及吞咽功能评估

Compare the results of supracricoid partial laryngectomy-cricohyoidopexy and horizontal-vertical hemilaryngectomy in the treatment of mid and late laryngeal carcinoma

目的:比较喉环状软骨上喉部分切除-环舌骨吻合术(SCPL-CHP)和水平垂直部分(3/4)喉切除术在治疗中晚期喉癌的疗效和术后评估。方法:回顾分析42例中晚期喉癌的临床资料,其中22例患者进行环舌骨吻合术(SCPL-CHP组)、20例患者行喉水平垂直部分切除术并Ⅰ期喉发声功能重建术(3/4喉切除术组),术后均补充放疗。通过言语可懂度、GRBAS评价标准和电声门图等检查对远期疗效和喉功能恢复情况进行评估。结果:42例喉癌患者术后均拔除气管套管,拔管率100%。术后拔管时间:SCPL-CHP组为(44.0±4.6)d;3/4喉切除术组为(39.0±2.7)d,2组术后拔管时间差异有统计学意义(t=4.239 5,P<0.01)。术后8周评估2组吞咽功能及术后1年评估患者语言可懂度差异均无统计学意义(P>0.05)。GRBAS评估中的G等级评估,2组间的差异有统计学意义(P<0.05)。SCPL-CHP组术后声嘶度以重度为主,而3/4喉切除术组多表现为中度。电声门图分析2组术式的F0比较差异无统计学意义(P>0.05),而SCPL-CHP组的jitter、shimmer、NNE较3/4喉切除术组均显著增高(P<0.05)。Kaplan-Meier法统计生存率显示:SCPL-CHP组和3/4喉切除术组患者3年及5年累积生存率分别为95.5%和89.7%,85.1%和83.7%,2组3年、5年的生存率差异均无统计学意义(P>0.05)。结论:根据中晚期喉癌发生的部位和累及的范围采用合适的术式及治疗方案,既能完整地切除喉肿瘤、不复发,又能良好地保留喉功能,而CHP术式具有更广泛的手术适应证及较好的临床应用前景,值得推广。

Objective： To compare the results of supracricoid partial laryngectomy-cricohyoidopexy（SCPL-CHP）and horizontal-vertical hemilaryngectomy in the treatmem of mid and late-laryngeal carcinoma. Method： Ret-rospective analysis on the types of mid and late stage of laryngeal carcinoma clinical material. 22 patients supracri-cold partial laryngectomy-cricohyoidopexy, 20 patients horizontal-vertical hemilaryngectomy, each with the added radiotherapy. The long term results of operation and glottic reconstruction .wexe evaluated by postoperative visit-ing; semi-quantitative speech intelligibility analysis, electrOglottograph（EGG） and so on. Result： Forty-two cases of laryngeal cancer patients were decannulated, the decannulation rate was 100%. Postoperative decannulation time：surgical CHP for（44.0±4.6）d, 3/4 throat operation for（39.0±2.7）d, two groups of postoperative decan-nulation time difference was statistically significant （t = 4. 239 5, P〈 0.01 ）. Eight weeks after evaluation, two groups＇s swallowing function and postoperative evaluation of patients-after one year speech intelligibility difference was not statistically significant（P〉0.05）. GRBAS in ＇the groups was statistically significant（P〈0.05）,CHP group 3/4 throat operation group mainly represented a moderate evaluation of G rating, the difference between the two showed, for most patients, a severe hoarse degree,but degree lever. EGG parameters were checked after 1 years.F0 comparative differences was not statistically significant（P〉0.05）, and the jitter, shimmer and NNE compared CHP group to 3/4 laryngeetomy group Were significantly increased （P〈 0. 05）. Kaplan-Meier method statistics show： CHP group and 3/4 laryngectomy group 3 years and 5 year accumulate survival rates were 95.5% and 89.7%, 85.1% and 83.7% respectively, two groups of three, five years of survival difference was not statistical-ly significant（P〉0.05）. Conclusion： According to the laryngeal of middle-late carcinoma, the region and the in-volvement of the scope were considered to choose appropriate surgical treatments, and both can complete resection of the tumor, and can retain good laryngeal functions,and CHP has a wider range of operation indications and clin-ical application prospect,is worthy to be popularized.