晚期喉癌的手术治疗(附26例报告)

Surgical management of advance laryngeal carcinoma in 26 patients with special emphasis on functional preservation

目的 探讨晚期喉癌手术治疗的方法及疗效。方法 对 1988～ 1999年间手术的 2 6例临床资料进行总结。按 1997年UICC修订方案分期 ,Ⅲ期 18例 ,Ⅳ期 8例。根据病变情况不同 ,采用相应的切除及修复方式。结果 全组喉部分切除术占6 5 .4 % (17/ 2 6 )。喉部分切除拔管率 94 .1% (16 / 17)。喉部分切除术患者的 3、5年生存率分别为 5 9.3%和 36 .2 % ,全喉切除患者 3、5年生存率分别为 6 6 .7%和 4 4 .9%。全组喉部分切除术与全喉切除术患者的生存率差异无显著性 (P >0 .0 5 )。结论 晚期喉癌手术保留喉功能是可行的 ,正确选择手术适应证 ,熟练掌握多种修复方法 ,可以提高晚期喉癌患者的生活质量。

Objective To explore the surgical methods and to evaluate the long-term result of laryngectomy in patients with advance laryngeal cancer. Methods A series of 26 cases underwent operation from 1988 to 1999 with 18 stage Ⅲ and 8 Stage Ⅳ. The choice of surgical procedure was decided according to the disease condition of the larynx. Result The ultimate rate of larynx preservation was 65.4%(17 /26). The decannulation rate was 94.1%(16 /17) in cases with preservation of laryngeal function. 3-year and 5-year survival rates were 59.3% and 36.2% in the survival cases with preserved laryngeal function, and were 66.7% and 44.9% in cases treated by total laryngectomy. The difference in the survival rates between these two groups was not statistically significant. Conclusion It is suggested that preservation of the laryngeal function can be succeeded for advanced laryngeal carcinoma without compromising the remote survival rate. The life quality of these patients can be improved by choosing correctly the surgical indications and by manipulating skillfully multiple repairing techniques.