喉癌部分喉切除术后误咽的分析

An Evaluation of the Deglutition Disorder after Partial Laryngectomy in Larryngeal carcinoma patients

目的评价喉部分切除术后发生误咽的相关因素,以减少术后误咽。方法对75例喉鳞癌病例的手术方式、年龄等与误咽发生率的关系进行回顾性分析,患者肿瘤分期T_1～T_4不等,年龄从38～80岁,平均年龄61.62岁。其中施行次全喉切除咽环状软骨吻合术51例,环状软骨上部分喉切除环状软骨舌骨会厌固定术(supracricoid partial laryngectomy woth cricohyoidoepiglottopexy,SCPL-CHEP)术21例,术后误咽病例共31例,声门上水平部分喉切除术3例。观测误咽情况。结果术后误咽患者31例,发生率为41.3%;发生误咽的平均年龄65.80岁。不同术式误咽发生率为次全喉切除咽环吻合术43%,SCPL+CHEP术38%,声门上水平半喉切除术33%。不同年龄误咽发生率49岁以下12.5%,50～59岁31.6%,60～69岁40.6%,70～75岁42.85%,75岁以上88.89%。结论手术方式及术后局部解剖结构的改变是误咽发生的决定因素。年龄与术后误咽有一定关系。

Purpose To evaluate the relative factors of the laryngeal carcinoma patients who underwent partial laryngectomy. Methods The relationship of the operative technique and the patient' s age to deglutition disorder in 75 laryngeal squamous cell carcinoma cases were retrospectively analyzed. The patients who underwent partial laryngectomy included 31 cases of sub-total laryngectomy 21 cases of SCPL-CHEP, and 3 cases of horizontal supraglottic laryngectomy. The staging of tumors were distinguished into T1 to T4, and the patient's age ranged from 38 to 80 years. The median age was 61.62 years. Results The postoperative deglutition disorder happened in 31 cases, the median age was 65.80 years, the occurrence rate was 41.3% . The variant rates of deglutition disorder in different techniques were: sub-total laryngectomy (43%), supracricoid partial laryngectomy with CHEF (38%), and horizontal supraglottic laryngectomy (33%) . The variant rates of postoperative deglutition disorder in different age ranges: and ever 49 years: 12.5% , 50 - 59 years:31.6% , 60 - 69 years; 40.6% ,70 - 75 years:42. 85% , up 75 years: 88. 89% . Conclusion The operative technique and the changes of postoperative topographic correlation are the decisive factors of deglutition disorder, and the disorder is significantly related with the age range of patients.