559例喉癌喉部分切除术的远期疗效观察  

Long-term follow-up study of 559 cases with laryngeal carcinoma

作　　者：于何[1] 王琰[1] 李笑天[1] 关超[1] 潘子民[1] 姜学钧[1] 

机构地区：[1]中国医科大学第一临床学院耳鼻咽喉科,沈阳110001

出　　处：《中华耳鼻咽喉头颈外科杂志》2009年第9期726-730,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的观察喉部分切除术的远期疗效及喉功能的恢复情况。方法总结中国医科大学第一附属医院耳鼻咽喉科1996至2002年各种喉部分切除术559例，其中男435例，女124例。按2002年UICC标准，声门上癌200例（Ⅰ期15例，Ⅱ期81例，Ⅲ期72例，Ⅳ期32例）；声门癌354例（Ⅰ期141例，Ⅱ期124例，Ⅲ期88例，Ⅳ期1例）；跨声门癌5例（Ⅱ期2例，Ⅲ期3例）。在彻底切除病变的基础上，尽量保留喉的正常组织和部分功能为术式选择的依据，安全缘≥5mm。其中声带切除术66例，垂直部分切除术119例，声门上水平部分切除术62例，水平垂直（3／4）部分切除术113例，喉次全切除环舌根会厌吻合术88例，喉近全切除环舌根吻合术（保留一侧杓状软骨）26例，喉癌激光切除术85例。同期行颈清扫术261例（单侧174例、双侧87例）。安全缘≤5mm或淋巴转移怀疑有残留时术后放疗。结果全部病例恢复发音功能。术后采用鼻饲管474例，7～24d全部克服误咽拔掉鼻饲管；466例（98．3％）在术后9d～3个月拔除气管套管。本组患者3、5、10年随访率分别为99．6％（557／559）、98．2％（549／559）、95．8％（183／191），直接法统计生存率，失访以死亡计。3年生存率为89．6％（501／559），其中声门上型Ⅰ＋Ⅱ期生存率为90．6％，Ⅲ＋Ⅳ期生存率为81．7％；声门型Ⅰ＋Ⅱ期生存率为95．2％，m＋Ⅳ期生存率为82．4％。5年生存率为75．0％（419／559），其中声门上型Ⅰ＋Ⅱ期生存率为75．0％，Ⅲ＋Ⅳ期生存率为62．5％；声门型Ⅰ＋Ⅱ期生存率为81．8％，Ⅲ＋Ⅳ期生存率为70．6％。10年生存率71．2％（136／191），其中声门上型Ⅰ＋Ⅱ期生存率为69．7％，Ⅲ＋Ⅳ期生存率为65．2％，声门型Ⅰ＋Ⅱ期生存率为77．6％，Ⅲ＋Ⅳ期生存率为72．1％。结论正确选择术式、手术切除范围和颈清扫方式以及适当�Objective To study the long-term follow-up result of partial laryugectomy and reservation of laryngeal function. Methods Five hundred and fifty-nine patients who underwent partial laryngectomy from 1996 to 2002 were summarized （male 435 eases, female 124 eases）. Among them, 200 eases were supraglottie carcinomas （ classified accordingly by UICC standard of years 2002 into： 15 cases of Ⅰ , 81 cases of Ⅱ , 72 cases ofⅢ, and 32 cases of Ⅳ ） , 354 cases were glottic carcinomas （ 141 cases of Ⅰ , 124 cases of Ⅱ , 88 cases of Ⅲ, and 1 cases of Ⅳ） , 5 cases were transglottic carcinomas （2 cases of Ⅱ and 3 cases of Ⅲ ）. In common 7 kinds of operations were performed：66 cases underwent cordectomy, 119 vertical laryngectomy, 62 horizontal supraglottic laryngectomy, 113 horizontovertical （3/4） laryngectomy, 88 subtotal laryngectomy with cricoglossoepiglottic anastomosis,26 neartotal laryngectomy with cricoglossal anastomosis （ with reservation of unilateral arytenoid cartilage ） , 85 laser laryngectomy. Two hundred and sixty-one cases underwent concurrent neck dissection （174 unilateral, 87 bilateral ）. Safety margin of less than or equal to 5 mm was suspected of having residual lymph node metastasis, the postoperative radiation therapy to treatment. Results All cases restored their phonation and overcame aspiration with removing nasal feeding from 7 to 24 days after operations. Four hundred and sixty-six cases were decannulated from 9 days to 3 months after operations. Decannulation rate was 98.3%. Through periodic review of out-patient clinics or telephone follow-up, family members follow-up a variety of ways, three, five or ten years follow-up rate： 99. 6% （557/559）, 98.2% （549/559）, 95.8% （ 183/191 ）, dollars lost to death. The three years survival rates were 89. 6% （501/559）. Among them, the survival rates for supraglottic carcinoma patients of stage Ⅰ and Ⅱ was 90. 6% , stage Ⅲ and Ⅳ 81.7% , for glottic carcinoma patient of stage Ⅰand Ⅱ

关 键 词：喉肿瘤 癌 鳞状细胞 喉切除术 存活率 

分 类 号：R686[医药卫生—骨科学]