51例喉全切除术的临床分析

Preliminary evaluation of total laryngectomy in 51 cases

目的 探讨喉全切除术及发音重建术的临床应用价值及疗效。方法 对1988年1月～2001年12月间51例喉癌及喉咽癌施行喉全切除术及部分施行发音重建术的病例进行回顾性分析。结果 51例全部施行喉全切除术,其中17例行气管(环)咽吻合术,发音成功率88.2％(15/17)。6例行新喉再造术,发音成功率100％。3例行食管气管造瘘术,发音成功率66.7％(2/3)。25例行气管皮肤造口术(咽-食管发音),发音成功率52％(13/25)。手术主要并发症咽瘘的发生率为17.6％(9/51)。5年生存率为64.7％(33/51)。结论 喉全切除术仍不失为治疗各种中、晚期喉癌及喉咽癌最基本、最安全的手术,特别是在喉全切基础上选择施行各种发音重建术,对病人恢复发音功能,提高病人生存质量,具有广泛临床应用价值。

Objective To evaluate the value and curative effect of the treatment of total laryngectomy and vocal rehabilitation after total larygectomy. Methods A retrospective analysis was conducted on 51 patients from January 1988 to December 2001 with total laryngectomy and partially performed the vocal rehabilitation for squamous cell carcinoma of the larynx or hypopharynx. Results The vocal rehabilitation of laryngectomized patients with tracheo (-cricoid-) pharyngostomy was performed on 17 patients, 15 of whom (88.2%) had acquired of speech function of different quality. The new laryngoplasty was performed on 6 patients, all of whom had acquired the function of speech of different quality. Tracheoesophageal fistula was performed on 3, 2 of whom could speak understandably (66.7 % ). Tracheostomy was performed on 25 cases, 13 (52% ) of whom could speak understandably. The incidence rate of the pharyngeal fistula in 51 cases was 17.6% (9 cases). The 5-year survival rate was 64. 7% (33/51). Conclusion Total laryngectomy plus the vocal rehabilitation of laryngectomized patients had wide clinical value, through which the patients improved the quality of living.