原发于声带后联合的声门型喉癌的手术治疗  

Surgical treatment for glottic carcinoma originated from posterior commissure

作　　者：沈晓辉[1] 高下[1] 俞成杰[1] 陈峰[1] 

机构地区：[1]南京大学医学院附属鼓楼医院耳鼻咽喉科,江苏南京210008

出　　处：《中国耳鼻咽喉颅底外科杂志》2008年第4期287-289,293,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的探讨治疗原发于声带后联合的恶性肿瘤的手术方式及预后。方法总结原发于声带后联合的恶性肿瘤患者8例,其中3例TisN0M0在支撑喉镜下手术切除;3例T1M0N0、2例T2N0M0常规行患侧Ⅱ、Ⅲ、Ⅳ区淋巴结清扫,部分喉切除,创面用带蒂胸骨舌骨肌肌瓣修复。结果术后2例患者病理证实患侧颈部淋巴结转移。8例患者术后均顺利拔管,有较好的发音和吞咽功能。随访5年,3例复发,其中1例死亡。结论原发于声带后联合的声门型喉癌,相对于一般声门型喉癌,复发率和颈部淋巴结转移率明显偏高,对于非原位癌的患者最好能同期行同侧颈廓清术,手术切缘应≥5.0mm。带蒂胸骨舌骨肌肌瓣是可以信赖的修复方法。Objective To explore the surgical method and prognosis of glottic carcinoma originated from the posterior commissure. Methods Clinical data of 8 patients with glottie carcinoma originated from posterior commissure was analyzed retrospectively. Of them, 3 cases at TisN0M0 received surgical treatment under self- retaining laryngoscope, while the others （3 eases at T1N0M0 and 2 at T2 N0M0 ） were treated with partial laryngectomy combined with ipsilateral neck dissection, and the laryngeal defects were reconstructed by a pedical sternohyoid muscle flap. Results All the cases had been followed up more than 5 yesrs postoperatively. All of them got extubated successfully with preferable phonatory and deglutitory function. Recurrence occurred in 3 cases and 1 died. Conclusion The recurrence rate and cervical lymphatic metastasis rate of glottie carcinoma originated from posterior commissure are significantly higher than those of the general type. Ipsilateral neck dissection is recommended except for tumor in situ and cutting edge should be over 5 mm away form the tumor. Pedical sternohyoid muscle flap is credible for the laryngeal defects.

关 键 词：喉肿瘤/外科学 颈淋巴结清扫术 胸骨舌骨肌瓣 

分 类 号：R739.65[医药卫生—肿瘤] R767.91[医药卫生—临床医学]