会厌正常声门上和声门区同时受累的喉癌手术及功能重建  

Surgery and function reconstruction of laryngeal cancer involved supraglottic and glottis area

作　　者：宋西成[1] 张庆泉[1] 张华[1] 孙岩[1] 王强[1] 柳忠禄[1] 王丽[1] 王艳[1] 陈秀梅[1] 宋轶鹏[2] 

机构地区：[1]青岛大学医学院附属烟台毓璜顶医院耳鼻咽喉头颈外科,264000 [2]青岛大学医学院附属烟台毓璜顶医院放疗科,264000

出　　处：《中华耳鼻咽喉头颈外科杂志》2013年第3期218-223,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：山东省科技发展计划（2011YD18014）;山东省优秀中青年科学家科研奖励基金（2007BS03009）;烟台市科技发展计划（2008142-21）

摘　　要：目的探讨保留会厌的声门上和声门区同时受累的喉癌手术方法、修复方式和术后功能状况。方法回顾性分析2005年6月至2010年12月97例会厌正常而声门上、声门区同时受累的喉癌患者，依据2002年UICC分期标准Ⅱ期37例，Ⅲ期41例，Ⅳ期19例。针对不同缺损范围和特点对86例行喉垂直部分切除术（vertical patial laryngectomy，VPL）和扩大喉垂直部分切除术（expanded vertical partial laryngectomy，EVPL），分别进行修复重建；11例行环舌骨会厌固定术（cricohyoidoepiglottopexy，CHEP）。术后对喉功能及相关生活质量进行评价。Kaplan—Meier计算生存率。结果全组病例3年、5年生存率为87．1％，69．6％。VPL和EVPL组、CHEP组3年、5年累积生存率为86．6％，68．3％和90．0％，78．8％，两组差异无统计学意义（P〉0．05）；术后总拔管率为88．7％，VPL／EVPL组拔管率为87．2％（75／86），CHEP组100％（11／11），两组差异无统计学意义（P〉0．05）。两组平均恢复进食时间（i-4-s）为（5．2±1．3）d和（15．7±5．2）d，CHEP组的时间长于VPL／EVPL组（P〈0．01）。CHEP组最大声时较短（Z=3．92，P〈0．01），清浊音比S／Z比值较高（Z=5．01，P〈0．01）；主观听感知GRBAS评分两组对比，G评分和B评分CHEP组要高（Z=4．43，Z=3．37，P〈0．01），R评分对比差异无统计学意义（P〉0．05）；嗓音障碍指数（voice handicap index，VHI）VHI-10评分VPL和EVPL组与CHEP组分别为（29．5±4．7）分和（31．6±6．3）分，差异无统计学意义（P〉0．05）。结论对于声门上和声门区同时受累而会厌正常的喉癌患者，至少一侧2／3甲状软骨板的保留以及会厌的存在和下移是实施喉垂直部分切除术式、顺利拔管的重要保障。Objective To investigate the surgery preserving epiglottis, the repair and the postoperative functions in laryngeal carcinoma involving supraglottic and glottic areas. Methods A total of 97 cases with laryngeal cancer involving both supraglottic and glottic areas with normal epiglottis underwent surgery between June 2005 and December 2010 was reviewed. Of them 37 cases were stage H , 41 cases were stage m, and 19 cases were stage IV. Vertical partial laryngeetomy（VPL） or extended VPL with the repair and functional reconstruction was carried out in 86 cases and cricohyoidoepiglottopexy （CHEP） in 11 cases. Postoperative survival rate, laryngeal functions and quality of life were evaluated. Results The 3-year and 5-year total cumulative survival rate （Kaplan-Meire survival analysis） were 87.1% and 69.6% in the 97 eases; 86. 6% and 68. 3% in VPL/EVPL group; 90. 0% and 78. 8% in CHEP group, respectively, with no significant difference between VPL/EVPL and CHEP groups （P 〉 0.05 ）. Of 97 cases, 86（88.7% ） cases were decannulated postoperatively. The rates of decannulation were 87.2% （75/86） in VPL/EVPL group and 100% （11/11） in CHEP group, with no significant difference （P 〉0.05）. Average oral diet recovery time of VPL/EVPL group and CHEP group was （5.2 -＋ 1.3 ） and （ 15.7 ＋ 5.2） days, respectively,with a significant difference （ P 〈 0. 01 ）. Voice evaluation showed the mean maximum phonation time of VPL/EVPL group was shorter than that of CHEP group （P 〈 0. O1 ） and the S/Z ratio of VPL/EVPL group was higher than that of CHEP group （P 〈 0.01 ）. Perceptual voice evaluation GRBAS ratings showed patients in VPL/EVPL group had higher G and B ratings compared to patients in CHEP group （P 〈0.01 ）, but no significant difference in R-rating between two groups （P 〉 0.05）. Voice handicap index-10 （VHI-10） scores of VPL/EVPL and CHEP groups were 29.5 ＋ 4.7 and 31.6 ＋ 6.3, respectively, no significant difference （P 〉 O. 05 ）. Conclusions Fo

关 键 词：喉肿瘤 癌 鳞状细胞 喉切除术 语音质量 吞咽障碍 生活质量 

分 类 号：R739.65[医药卫生—肿瘤]