喉声门上水平部分切除术163例  

Supraglottic horizontal partial laryngectomies in 163 cases

作　　者：贾深汕[1] 项丞[1] 刘伟松[1] 何洪江[1] 

机构地区：[1]哈尔滨医科大学附属肿瘤医院头颈外科,150040

出　　处：《中华耳鼻咽喉头颈外科杂志》2006年第10期763-766,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨喉声门上水平部分切除术的临床应用价值。方法回顾自1978至1998年施行喉声门上水平部分切除术163例的临床资料。按 UICC 2002年标准分期:Ⅰ期5例,Ⅱ期95例,Ⅲ期48例,Ⅳ期15例。对喉声门上水平部分切除术进行一些改进:常规切除舌骨;用甲状软骨外骨膜内翻与喉室切缘缝合;减少梨状窝内壁黏膜游离范围;甲状软骨与舌根肌肉吻合时由舌根黏膜下进针并尽量多带一些肌肉,使其与甲状软骨板断缘紧密对合。结果 Kaplan-Meier 法分别统计Ⅰ～Ⅳ期全部患者的5年生存率分别为:Ⅰ期100.0%;Ⅱ期77.9%;Ⅲ期为54.2%;Ⅳ期为33.3%。不同临床分期患者组间生存率比较,差异有统计学意义(P=0.0006)。临床检查颈淋巴结未见转移(cN0)和有转移(cN+)患者术后5年生存率分别为:73.1%和45.5%,两者比较差异有统计学意义(P=0.0132)。吞咽功能全恢复。发音功能良好。拔管率为91.4%(149/163)。颈部隐匿性转移率为23.1%(30/130),cNl-3颈转移率为75.8%(25/33),总转移率为33.7%(55/163)。随诊发现致死原因主要为颈淋巴转移,占40.0%(20/50)。喉部复发致死占18.0%(9/50)。结论改进后的喉声门上水平部分切除术为部分声门上喉癌外科治疗的较为理想术式。建议声门上癌 cN0患者行择区性颈侧清扫术。Objective To evaluate the clinical value of supraglottic horizontal partial laryngectomy. Methods One hundred and sixty-three patients with supraglottie laryngeal carcinoma were treated surgically by supraglottie horizontal partial laryngeetomy from 1978 to 1998. There were 64 males and 99 females. Five cases were staged I ,95 staged Ⅱ ,48 staged Ⅲ and 15 staged Ⅳ. The surgical techniques were improved： The hyoid was removed conventionally; The outer periehondrium of thyroid cartilage was turned into the laryngeal cavity and sutured with the mueosa of laryngeal ventricle and the base of tongue was sutured to the reserved thyroid cartilage. Survival was evaluated using the Kaplan-Meier method. The differences between stages were tested by Los-Rank method. Results The 5-year survival rate were 100.0% ,77. 9% ,54. 2% and 33.3 % for patients staged I to IV respectively, and were statistically significant （P =0. 0006） between different clinical stages. The 5-year survival rate were 73. 1% and 45.5% in patients with cN0 and cN ＋ respectively, and were statistically significant （P = 0. 0132）. The speech and swallowing functions were good after operation. The decannulation rate was 91.4%. The main causes of death were cervical lymph node metastasis in 40% （20/50） and laryngeal recurrence in 18% （9/50）. The occult metastasis rate was 23.1% （30/130） and cervical metastasis rates of patients with cN1-3 75.8% （25/33）, with a total metastasis rate was 33.7 （55/163）. Conclusions Supraglottie horizontal partial laryngectomy is very effective in eradicating disease and in preserving laryngeal function on condition that the indications were selected correctly. The selective lateral neck dissection was recommended for supraglottie carcinoma.

关 键 词：喉切除术 存活率 颈淋巴结清扫术 

分 类 号：R739.65[医药卫生—肿瘤]