早期声门区癌的手术治疗及疗效评估  

A clinical study of the surgical treatment for early stage glottic carcinoma

作　　者：王晓彬[1,2] 潘新良[3] 卢永田[1,2] 魏明辉[1,2] 孙焕吉[1,2] 苗北平[1,2] 

机构地区：[1]深圳市第二人民医院 [2]深圳大学第一附属医院耳鼻咽喉头颈外科,广东深圳518035 [3]山东大学齐鲁医院耳鼻咽喉头颈外科,济南250012

出　　处：《山东大学耳鼻喉眼学报》2013年第4期53-58,共6页Journal of Otolaryngology and Ophthalmology of Shandong University

摘　　要：目的探讨T1、T2早期声门型喉癌的治疗方法。方法对112例T1、T2早期声门型喉癌(其中T1N0M080例、T2N0M032例)患者施行喉小部分切除术。结果 112例患者切口均Ⅰ期愈合,6～7 d拆线,术后2～3 d恢复经口进食,术后第5～6 d更换小号气管套管,1～2d后试堵管,平均戴管时间7.3 d,拔管率100%;纤维喉镜检查见术后6个月声门裂形态接近正常且闭合严密。嗓音学分析结果示术前、术后1周与术后2个月、6个月Shimmer和NNE对比,差异有统计学意义(P<0.01);随访满3年76例,全部生存;满5年36例,35例生存(1例不明原因死亡),生存率97.2%。结论早期声门区喉癌施行喉部分切除术,疗效确切,可获得稳定的局部控制率。在彻底切除肿瘤的前提下,最大限度地减少了手术造成的创伤,住院时间缩短,患者及家属的经济负担减轻,最大程度地保留和重建了患者的喉功能。Objective To explore the surgery way for T1 and T2 glottic carcinoma. Methods From 2003 to 2010, small partial laryngectomy was performed on 112 patients with T1 or T2 （80 with T1N0M0 and 32 with T2N0M0 ） glottic carcinoma. By a retrospective review of the surgery approach, the curative results and advantages of the surgery treat- ment, dynamic follow-up of the movement of the arytenoid cartilage, reconstruction of the glottis rimae and the changes of the voice were analyzed. The pre-operative and post-operative voice qualities were compared with the software of Dr. Speech system for windows. Results All patients were healed in one stage about 6 or 7 days and took food with mouth post-operatively 2 or 3 days, and the mean time of all patients with cannula was 7.3 days. The removal rate of the trachea cannula was 100 %. The movement of the arytenoid cartilage of 47 cases 1 week after surgery was weak- ened, the reconstructed glottis rimae was close to be normal 6 months after operation. There was no significant differ- ence in Shimmer and NNE before and 1 week after operation（ P 〉0.05 ）, but there was significant difference before and 2 months and half a year after operation, and there was also significant difference 1 week, 2 months and 6 months after operation（P 〈0.01 ）. 76 cases survived during 3 years＇ follow-up, 35 of 36 cases survived in 5 years＇ follow-up post- operatively （1 case died without definite causes）. Conclusion Partial laryngectomy achieves satisfied curative results and provides a clear operative view to resect the tumor completely, reconstruct the function of the larynx and improve the voice quality of the patients post-operatively. Therefore, partial laryngectomy is effective for T1 or T2 （T1N0M0, T2N0M0 ） glottic carcinoma.

关 键 词：喉肿瘤 喉切除术 喉功能重建 嗓音声学分析 

分 类 号：R739.65[医药卫生—肿瘤]