声门型喉癌喉功能保全术的临床应用研究

目的探讨传统的垂直部分喉切除术和改良垂直半喉切除术治疗声门型喉癌的临床效果。方法回顾性分析2001-2009年行传统的垂直部分喉切除术(传统组)和改良垂直半喉切除术(改良组)的声门型喉癌患者的临床资料,比较两种手术方式术后患者喉功能及生存率等方面的统计学差异。传统组:34例患者,T112例,T222例。改良组:27例患者,T15例,T219例,T33例。结果发音功能:传统组患者术后发音正常者6例,良好者11例,中度者3例,差者1例;改良组患者术后发音正常者16例,良好者6例,中度者1例,差者0例,两组间有显著差别(P<0.05)。吞咽功能:传统组患者术后无误咽9例,轻度误咽10例,中度误咽3例,改良组患者术后无误咽20例,轻度误咽2例,中度误咽1例,两组间有显著差别(P<0.05)。呼吸功能(术后拔管率):传统组为91.1%(31/34),改良组为100.0%(27/27),两组间无显著差别(P<0.05)。Kaplan-Meier法统计生存率,传统组3年累积生存率为93.5%,改良组为96.0%,两组间无显著差别(P>0.05)。结论改良术式在肿瘤根治率上和经典术式无差别,而在喉功能保全方面优于传统术式。

Objective To explore the clinical effect of traditional vertical laryngectomy and improved vertical partial laryngectomy in the treatment of laryngeal carcinoma. Methods Retrospectively analyzed on the results and prognosis in patients underwent traditional vertical laryngectomy（Traditional group for short） and improved vertical partial laryngectomy（Improved group for short）between 2001 and 2009, compare two operation method on the patients with laryngeal function and the differences of survival. Traditional group consisted of 34 patients （stage T1 12 cages, stage T 2 22 cages）and improved group consisted of 27 cases （stage T1 5 cages, stage T 2 19 cages,stage T 3 3 cases）. Results Pronunciation function,traditional group 6 cases of normal, fluent in 11 cases,moderate in 3,dealing in 1,improved group 16 cases of normal, fluent in 6 cases, moderate in 1.Swallowing function：traditional group 9 cases no aspiration,10 cases mild aspiration, 3 cases moderate ~ Improved group 20 cases no aspiration, 2 mild cases,3 moderate aspiration. Respiratory function： The decannulation rate was 91.1%（31 / 34）in extended vertical partial laryngectomy group and 100.0% （27/27）in improved group. Kaplan-Meier analysis Wag performed to calculate the survival rates. The three-year calculate survival rate was 93.5% in improved group and 96.0%in traditional group. Gonelusion Although the survival rate was no different befween the two groups, in laryngeal functional preservation is better than that in Classical operation.