环状软骨上部分喉切除治疗79例喉鳞状细胞癌的疗效分析

Supracricoid partial laryngectomy foRlaryngeal squamous cell carcinoma:Efficacy analysis in 79 cases

目的:探讨环状软骨上部分喉切除治疗声门型及声门上型喉鳞状细胞癌的远期疗效。方法:回顾性分析2012年12月~2018年6月弋矶山医院耳鼻咽喉头颈外科收治的79例喉癌患者的临床资料,对其术后功能恢复、有无术后并发症、肿瘤复发转移及总体生存率等数据进行统计学分析,评估其治疗效果。结果:平均随访时间(45.24±6.84)个月(8~76个月),声门上型16例,声门型63例。声门上型喉癌的手术方式为环状软骨舌骨固定术,其术后1年、3年和5年总生存率分别为100.00%、93.75%和81.25%,1年、3年和5年的局部控制率为100.00%、87.50%和75.00%。声门型喉癌的手术方式为环状软骨舌骨会厌固定术,其术后1年、3年和5年总生存率为100.00%、95.24%和84.13%,1年、3年和5年的局部控制率为100.00%、92.06%和80.95%。术后气管套管拔管率为94.95%,平均拔管时间为(28.30±3.72)d;鼻饲管拔管率为93.67%,平均拔管时间为(21.50±3.48)d,声门型喉癌的平均拔管时间短于声门上型喉癌患者。结论:环状软骨上部分喉切除术适用于声门型和声门上型喉癌,术后保留了患者的发声和呼吸功能,尽管吞咽功能短期内受到影响,其仍为部分喉切除的标准手术方案之一。

Objective:To assess the long-term efficacy of supracricoid partial laryngectomy(SCPL)in the treatment of laryngeal squamous cell carcinoma.Methods:Retrospective analysis was performed in 79 cases of laryngeal carcinoma(treated in ouRhospital between DecembeR2012 and June 2018)regarding the clinical data,functional recovery,postoperative complications,tumoRrecurrence and metastasis and overall survival rate.The therapeutic effects were evaluated through statistical data analysis.Results:The mean follow-up was(45.24±6.84)months(ranging from 8 to 76 months).Of the 79 cases,16 were associated with supraglottic,and 63 with glottic type.Patients with supraglottic carcinoma underwent cricohyoidopexy(CHP).The overall survival rate by 1 year,3 and 5 years were 100.00%,93.75%and 81.25%,and the local control rate by 1 year,3 and 5 years was 100%,87.50%and 75.00%,respectively.Patients with glottic carcinoma were treated by cricohyoidoepiglottopexy(CHEP),whose overall post-operative survival rate by 1 year,3 and 5 years was 100%,95.24%and 84.13%,and local control rate was 100.00%,92.06%and 80.95%,respectively.The rate of tracheal extubation was 94.95%,and the average extubation time was(28.30±3.72)days.Removal rate of nasal feeding tube was 93.67%,and the average time was(21.50±3.48)days.The average extubation time was earlieRin patients with glottic laryngeal canceRthan those with supraglottic laryngeal tumor.Conclusion:Supracricoid partial laryngectomy can be favorable to both supraglottic and glottic laryngeal carcinoma,and lead to preserved vocal and respiratory functions following surgery.Although swallowing function is affected in the short time,yet this surgical modality still remains standard procedure foRpartial laryngectomy.