喉癌的手术治疗与喉功能的保护

Surgical management of laryngeal cancer and preservation of laryngeal function

目的 探讨喉癌手术治疗的方法与喉功能重建及其疗效。方法 对 1 979～ 1 999年间62 5例喉癌患者进行手术治疗。其中声门上癌 1 82例 :Ⅰ期 1 1例 ,Ⅱ期 45例 ,Ⅲ期 49例 ,Ⅳ期 77例 ;声门癌 42 9例 :Ⅰ期 1 4 6例 ,Ⅱ期 1 1 3例 ,Ⅲ期 98例 ,Ⅳ期 72例 ;声门下癌 1 4例 :Ⅰ期 1例 ,Ⅱ期 4例 ,Ⅲ期 2例 ,Ⅳ期 7例。根据病变情况不同 ,采用相应的手术方式。结果 喉部分切除占全部病例的比例为 83 .4% (52 1 62 5)。喉部分切除术拔管率为 84.1 % (438 52 1 )。Ⅲ、Ⅳ期患者中 ,喉部分切除比例为66 .6 % (2 0 3 30 5)。全部患者恢复经口进食 ,喉部分切除患者均成功恢复发音。全部喉癌患者 3年生存率为 89.6 % ,5年生存率为 77.4%。Ⅲ、Ⅳ期喉部分切除术和全喉切除术患者的生存率差异无显著意义 (P >0 .0 5)。结论 晚期喉癌保留喉功能是可行的。熟练掌握多种修复方法 ,择优采用 。

Objective To explore the surgical methods for laryngeal cancer and long term effects of larygectomy. Methods 625 cases of laryngeal cancer at different stages, including 182 cases of supraglottic cancer, 429 cases of glottic cancer, and 14 cases of subglottic cancer, underwent operation of different kinds from 1979 to 1999. Radiotherapy was given to those with poorly differentiated squamous carcinoma or with metastasis of cervical lymph nodes postoperatively. The effects of operation, especially that on the preservation of laryngeal function was analyzed. Results Partial laryngectomy was performed on 521 of the 625 cases (83.4%) and 203 of the 305 cases at stages Ⅲ and Ⅳ (66.6%). The decannulation rate was 84.07% in the cases undergoing partial laryngectomy. The nasal feeding tube was removed and peroral feeding was recovered in all patients. All cases undergoing partial laryngectomy succeeded in phonation. The overall 3 year survival rate was 89.63% and the overall 5 year survival rate was 77.36%. For the cases with laryngeal cancer at stages Ⅲ and Ⅳ, the 3 year survival rate among those undergoing partial laryngectomy was 84.9%, not significantly different from that among those cases undergoing total laryngectomy (87.7%, P >0.05); the 5 year survival rate was 66.6% among those undergoing partial laryngectomy and was 69.7% among those undergoing totals laryngectomy ( P >0.05). Conclusion The rate of partial laryngectomy is rather high in this group. It is possible to preserve the laryngeal function without compromising the remote survival rate. The prerequisite for the preservation of laryngeal function is to master and choose the proper renovation methods