喉声门型癌声门下受侵与外科治疗选择  

Glottic carcinoma with subglottic extension and surgical procedures

作　　者：温树信[1] 唐平章[1] 徐震纲[1] 祁永发[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院头颈外科,北京100021

出　　处：《中国耳鼻咽喉头颈外科》2005年第4期211-214,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨喉声门型癌声门下受侵合适的外科治疗方式。方法回顾性分析102例喉声门型癌声门下受侵患者的局部声门下受侵范围及所行手术方式。根据受侵范围,将患者分为两组。第一组为声门下受侵在声带游离缘下0.5cm～1.0cm之间,第二组为声门下受侵达声带游离缘下1.0cm以上。分析比较两组患者的不同手术方式的3年无瘤生存率及淋巴结转移率。结果102例喉声门型癌声门下受侵患者总的3年无瘤生存率为58.8%。两组的生存率分别为66.7%(22/33)、55.1%(38/69)。第一组病例喉全切除术、喉近全切除术、喉部分切除术的生存率分别为60.0%(6/10)、2/2、66.7%(14/21);第二组病例喉全切除术、喉近全切除术、喉部分切除术的生存率分别为58.7%(27/46)、50.0%(6/12)、45.5%(5/11)。本资料两组患者的淋巴结阳性率分别为6.1%(2/33)、15.9%(11/69)。淋巴结阳性与阴性患者的生存率分别为23.1%(3/13)、64.0%(57/89)。结论声门下受侵是影响喉声门型癌预后的一个较为重要因素。喉声门型癌声门下受侵患者,声门下受侵范围未超过声带游离缘下1.0cm,如无其它禁忌证,应行喉部分切除术;声门下受侵范围超过声带游离缘下1.0cm,应考虑行喉全切除术。淋巴结转移是影响声门下受侵喉声门型癌的重要因素,随着声门下受侵范围的增大,淋巴结转移率也随之增高。OBJECTIVE To seek for the optimal sur-gical modalities for glottic carcinoma with subglotticextension. METHODS A series of 102 cases with glot-tic carcinoma involving subglottic region were retrospec-tively reviewed. By the subglottic range involved, allcases were divided into two groups. The first group wasdefined as subglottic extension from 0.5cm to 1.0 cmbelow the free margin of the true vocal cord. The sec-ond group was defined as subglottic extension over1.0 cm below the free margin of the true vocal cord.Lymphatic node metastasis rates and 3 year free dis-ease survival rates were analyzed between the twogroups. The patients were involved in three surgicalmodalities, total laryngectomy, near total laryngectomyand partial laryngectomy. RESULTS The 3 year freedisease survival rate of all cases was 58.8 %. The sur-vival rates of the first and second groups were 66.7 %and 55.1 % respectively. In the first group, the 3-yearsurvival rates of the cases performed with totallaryngectomy, near total laryngectomy and partial la-ryngectomy were 60.0 %(6/10), 2/2, 66.7 %(14/21)respectively. In the second group, the survival rates ofthe cases performed with total laryngectomy, near to-tal laryngectomy and partial laryngectomy were 58.7 %(27/46), 50.0 %(6/12), 45.5 %(5/11) respectively. Thelymphatic node metastasis rate of all cases was12.7 %. The lymphatic node metastasis rates of thefirst and second groups were 6.1 %(2/33) and 15.9 %(11/69) respectively. The survival rates of the cases withpositive lymphatic nodes and the cases with negative lymphatic node were 23.1 %(3/13) and 64.0 %(57/89)respectively. CONCLUSION The subglottic extensionplayed a role in the prognosis of glottic carcinoma. With-out contraindications, the glottic carcinoma with sub-glottic extension from 0.5cm to 1.0 cm below the freemargin of the true vocal cord should be performed withpartial laryngectomy. The glottic carcinoma with sub-glottic extension over 1.0 cm below the free margin of the true vocal cord should be performed with totallaryngectom

关 键 词：喉声门型癌 声门下 外科治疗 喉部分切除术 淋巴结转移率 喉近全切除术 喉全切除术 受侵范围 无瘤生存率 淋巴结阳性率 手术方式 回顾性分析 治疗方式 分析比较 阴性患者 游离 声带 禁忌证 病例 

分 类 号：R739.65[医药卫生—肿瘤] R767.11[医药卫生—临床医学]