累及前联合的早期声门型喉癌的手术选择及临床分析

Surgical methods and clinical analysis of early-stage glottic carcinoma involved anterior commissure

目的:探讨累及前联合的早期声门型喉癌的手术方法。方法:回顾分析58例累及前联合的早期声门型喉癌临床资料,其中T1病变23例,T2病变35例,分别行侧前位喉部分切除术36例,无气管切开额前位喉部分切除7例,无气管切开的改良侧前位喉部分切除15例。结果:经治疗后所有患者发声及吞咽功能得到较好的恢复;1例侧前位喉部分切除术后未拔管,拔管率为97.2%;未做气管切开喉部分切除术者,1例术后因呼吸困难行气管切开,6例术后出现颈胸部皮下气肿,经加压包扎或皮下放置负压引流管,出院前均消失,无其他并发症。随访6个月～7年,复发3例,3、5年生存率分别为97.5%和91.8%。结论:合理选择最佳的术式,可使患者获取较好的肿瘤学和功能学检测结果,减轻患者痛苦,有利于提高生存质量。

Objective： To explore the surgical methods for management of early-stage glottic carcinoma in- volved anterior commissure. Method： Fifty-eight cases of early-stage glottic carcinoma（T1 , n = 23 ; T2, n = 35 ） trea- ted with vertical frontolateral partial laryngectomy and frontal partial laryngectomy or modified window partial lar- yngectomy without tracheostomy were retrospectively reviewed. Result： All patients can swallow smoothly and phonate clearly after operation. And the extubation rate with vertical frontovertical partial [aryngectomy is 97.2 ~. Tracheostomy was performed in one case after operation because of dyspnea. The most.common postoper- ative complication was subcutaneous emphysema which developed postoperatively in 6 patients, but subsided after discharge. Follow-up was conducted for 8 months to 7 years, recurrence was observed in 3 cases. The 3 and 5 year survival rates were 97.5% and 91.8%respectively. Conclusion：To choose the optimal surgical method for patients with early-stage glottic carcinoma not only can reduce the risk of recurrence hut also can save the laryngeal function and thus improves the quality of life.