改良环状软骨上喉次全切除术疗效分析

Therapeutic effect of improved supracricoid subtotal laryngectomy for the treatment of laryngeal carcinoma

目的探讨改良环状软骨上喉次全切除术的可行性及优越性。方法随机选取25例早中期喉癌患者,行改良环状软骨上喉次全切除术,并以残存的披裂黏膜翻转进行发音重建,同时将环状软骨或环甲膜直接与下拉的会厌缝合,完成环会厌吻合,重建喉功能,术后随访,并3年估疗效。结果术后随访1～3年,25例患者无一例死亡,拔管率为100%,平均拔管时间为45 d;误吸发生率为52%,所有患者发音较清晰,均能进行正常的言语交流; 1例患者出现术后颈部淋巴结转移,再次行功能性颈淋巴结清扫; 1例患者喉癌局部复发,再次行全喉切除。结论改良环状软骨上喉次全切除术,该术式操作简单,易掌握,可有效提高术后拔管率,降低喉狭窄发生率,提高发音质量,改善患者术后的生存质量。

Objective To explore the feasibility and superiority of improved supracricoid partial laryngectomy for the treatment of laryngeal carcinoma. Methods 25 patients suffering from laryngeal carcinoma of early and medium stage received improved supracricoid partial laryngectomy. During the operation,phonation function was reconstructed with reversal of residual arytenoid mucosa,combined with simultaneous crico-epiglotto-pexy via direct suture of epiglottis with cricoid cartilage or cricothyroid membrane. All patients were followed up postoperatively to evaluate the therapeutic effect.Results During the follow-up period ranged from 1 to 3 years,no death occurred. The decannulation rate was 100% with an average decannulation time of 45 days. The incidence of aspiration was 52%. All patients had clear pronunciation as well as normal verbal communication. One patient underwent postoperative functional neck dissection due to cervical lymph node metastasis,and another one received total laryngetomy due to postoperative local recurrence. Conclusion With advantages of simple maneuverability and easy grasping,the improved supracricoid partial laryngectomy can effectively improve the postoperative decannulation rate, reduce the incidence of laryngeal stenosis, improve the quality of pronunciation as well as the quality of life in patients with laryngeal carcinoma.