两种垂直部分喉切除术对声门型喉癌患者喉部功能、术后拔管率及生存率的影响

Effects of two kinds of vertical partial laryngectomy on laryngeal function. postoperative extubation rate and survival rate of patients with glottic laryngeal carcinoma

目的研究两种垂直部分喉切除术对声门型喉癌患者喉部功能、术后拔管率及生存率的影响'一方法选择湖州市福音医院2013年1月至2014年1月治疗的声门型喉癌患者150例,采用随机数字表法分为观察组75例和对照组75例对照组应用传统垂直部分喉切除术,观察组采用改良垂直半喉切除术观察两组患者的术后生存率、拔管率、拔管时间及并发症发生情况等结果观察组拔管率为100. 00%(75/75),对照组拔管率为97.33%(73/75),差异无统计学意义(χ^2=0. 027,P > 0. 05 );观察组拔管时间为(11.85 ±0.49)d,对照组拔管时间为(14.55±0.56)d,差异有统计学意义(t= 31.424,P <0. 05 )观察组吞咽功能分级0级67例(89. 33%), 1级8例(10.67%),吞咽功能优于对照组,差异有统计学意义(Z = 5.238,P<0. 05).两组患者术后1年和术后2年的生存率差异均无统计学意义(均P〉0.05),观察组患者术后3年的生存率为97. 33%(73/75),对照组为88.00%(66/75)( χ^2=4. 807 p<0.05 ) 0两组患者均未出现咽痿,对照组出现5例切口感染,观察组出现1例切口感染,两组患者并发症发生率差异无统计学意义(χ^2 =2.778,P =0.096)结论改良乖直半喉切除术治疗声门型喉癌患者能有效缩短拔管时间,较好地保存患者喉部吞咽功能,提高3年生存率,但拔管率、并发症发生率与传统垂直部分喉切除术并无明显差异。

Objective To study the effects of two kinds of vertical partial laryngectomy on laiyngeal function, postoperative extubation rale and survival rate of patients with glottic laryngeal carcinoma. Methods From January 2013 to January 2014, one hundred and fifty patients with glottic carcinoma who treated in Huzhou Gospel Hospital were selected. The patients were divided into observation group and control group by random number table method,with 75 cases in each group. The i-ontrol group used the traditional vertical partial laryngectomy,the observation group was treated with modified vertical partial laryngectomy. Tlie postoperative surxival rate, extubation rate, extubation time and complications were obsen ed in the two groups. Results The extubation rate was 100. 00%(75/75 ) in the observation group and 97. 33%( 73/75 ) in the control group, the difference was statistically significant between the two groups(χ^2= 2. 027 ,P >0. 05 ). The extubation time in the observation group was ( 11.85 ± 0. 49) d, which in the control group was ( 14. 55 ± 0. 56) d, the difference was statistically significant between the two groups (t =31.424, P <0. 05 ). There were 67 cases ( 89. 33%) with grade 0 and 8 cases ( 10. 67%) with grade I in the observation group. The swallowing function of the observation group was stronger than that of the control group( Z = 5. 238 , P < 0. 05 ). The 1 - year and 2 - year sun ival rates of the two groups were similar( all P〉0. 05 ). The 3 - year survival rate of the observation group was 97. 33%(73/75 ), which of the control group was only 88. 00%(66/75), the difference was statistically significant between the two groups ( χ^2=4. 807 <0. 05 ). There was no pharyngeal fistula in both two groups. There were 5 incision infections in the control group, and 1 incision infection in the observation group. There was no statistically significant difference in the incidence rate of complications between the two groups (χ^2= 2. 778 , P > 0. 05 ). Conclusion Improved vertical hrmilaryngectomy therapy for patients with glottic laryngeal carcinoma can effectively shorten the time of extubation, better preserve swallowing function, improve the long -term survival rate,and the extubation rate and complication rate are similar with the traditional vertical partial laryngectomy.