381例喉癌保留喉功能的手术治疗

Preservation of laryngeal function in surgical treatment of laryngeal carcinoma

目的 探讨喉癌各种保留喉功能手术的手术方法及临床疗效.方法 对2000-2008年间蚌埠医学院第一附属医院耳鼻咽喉科381例经部分喉切除治疗的喉癌患者的临床资料进行回顾性分析,统计分析喉功能保留的手术方法、 喉功能恢复情况、生存率和死亡原因等.其中,男360例,女21例,按2002年UICC标准,声门上癌120例（I期13例,Ⅱ期52例,Ⅲ期52例,Ⅳ期3例）;声门癌247例（I期69例,Ⅱ期113例,Ⅲ期63例,Ⅳ期2例）;声门下癌5例（Ⅱ期4例,Ⅲ期1例）,声门旁癌9例（Ⅱ期4例,Ⅲ期5例）.保留喉功能手术方法包括：声带切除术31例（支撑喉镜下声带切除6例,喉裂开声带切除25例）,喉额侧部分切除术22例,喉垂直部分切除术81例,喉声门上水平部分切除46例,喉水平垂直部分切除术（3/4）70例,喉环状软骨上部分切除术114例（CHEP83例,CHP31例）,喉近全切除术8例,Tucke喉部分切术9例,同期行颈清扫术199例（单侧120例,双侧79例）.术前放疗22例,剂量40~50Gy,术后辅助放疗118例,放疗剂量50~60Gy.Kaplan-Meie计算生存率,log-rank检验单因素生存分析.结果 全部病例均恢复发音及吞咽功能,拔管率：90.8%（346/381）,平均胃管拔出时间17天,发音中等及良好者332例.总体患者3年生存率为87.4%（333/381）,其中声门上型为80.0%（96/120）,声门型为92.3%（228/247）,声门下型为3/5,声门旁型为6/9;I期为96.3%（79/82）,Ⅱ期为89.0%（154/173）,Ⅲ期为81.0%（98/121）,Ⅳ期为2/5.5年生存率为78.2%（298/381）,其中声门上型为66.7%（80/120）,声门型为85.8%（212/247）,声门下型为2/5,声门旁型为4/9;I期为93.1%（77/82）,Ⅱ期为80.3%（139/173）,Ⅲ期为67.8%（82/121）,Ⅳ期为1/5.单因素分析显示肿瘤的不同部位（声门型与声门上型）、临床分期及淋巴结有无转移患者之间生存率差异有统计学意义（P〈0.05）,不同的喉功能保留术式患者之间生存率差异无统计学意义（P＆gt;0.05）.结论 喉功能保留手术疗效肯定,术后患者生活质量明显提高.但严格掌握手术适应证、选择正确术式、正确的修复技术是保证手术的疗效及喉功能恢复的必要条件.

Objective To study the surgical methods of partial laryngectomy and the long-term follow-up result. Methods This was a retrospective analysis of 381 patients with partial laryngectomy between 2000 and 2008 in our department. Among them.male 360 cases,female 21 cases.120eases were supraglottic carcinomas （classified accordingly by UICC standard of years 2002 into：13cases ofⅠ, 52 eases ofⅡ, 52cases ofⅢ, and 3cases of IV）. 247 eases were glottic carcinomas （69 cases of Ⅰ,113 cases ofⅡ, 63 cases ofⅢand 2 cases of IV）, 5cases were subglottic carcinoma （4cases of Ⅱand 1 cases ofⅢ）, 9cases were transglottic carcinoma （4cases of Ⅱ and 5cases of Ⅲ）. In common 8 kinds of operations were performed：31 cases underwent cordectomy, 22 lateral partial laryngectomy,81vertical laryngectomy,46 horizontal supraglottie laryngeetomy, 70 horizontovertical（3/4） laryngeetomy, 114 supracricoid partial laryngectomy （SCPL-CHEP 83,SCPL-CHP31 ）, 8 neartotal laryngectomy with person,s techniques, 9 Tucker laryngectomy. 199cases underwent concurrent neck dissection（120 unilateral, 79 bilatera）. 22 cases were received preoperation radiotherapy with the dosage for40~50 Gy, 118 cases were received postoperation radiotherapy with the dosage for 50~60 Gy.Results：AlI of the patients restored the phonation and swallowing function.The decannuIation rate was 90.8%（346/381）, The three years survival rates were 87.4%（333/381）, Among them.the survival rates for supraglottic carcinoma patients were 80.0%（96/120）, glottic carcinoma 92.3%（228/247）, subglottic carcinoma 3/5, transglottic carcinoma 6/9, stage I 96.3%（78/82）, stageⅡ 89.0%（154/173）, stage Ⅲ 81.0%（98/121） and stage IV 2/5. The five years survival rates were 78.2%（298/381） , Among them, supraglottic carcinoma patients were 66.7%（80/120）, glottic carcinoma 85.8%（217/247）, subglottic carcinoma 2/5, transglottic carcinoma 4/9,stage I 93.1%（77/82）, stageⅡ 80.3%（139/173）, stageⅢ67.8%（82/121） and stage IV 1/5. Univariate analysis showed that primary site （glottic carcinomas and supraglottic carcinoma）, clinical stage, and N-stage were proven to significant （P〈0.05）, the operation methods were no significant （P＆gt;0.05）. Conclusions Partial laryngectomy is justified and effective in improving the quality of life in patients, but Strict indications,correct procedure and surgical repair methods are the keys to ensure the efficacy and preservation of larygeal function.