环状软骨舌骨吻合术和喉水平垂直部分切除术对中晚期喉癌患者术后嗓音及吞咽功能的影响  

Influence of supracricoid partial laryngectomy-cricohyoidopexy and horizontal-vertical hemilaryngectomy on voice and swallowing function in patients with mid and late stage laryngeal carcinoma

作　　者：严景辉[1] 王豪[1] 韦业通[1] 韦文[1] 

机构地区：[1]惠州市第三人民医院耳鼻喉科,广东惠州516002

出　　处：《海南医学》2015年第22期3314-3317,共4页Hainan Medical Journal

摘　　要：目的探讨喉水平垂直部分切除术与环状软骨上喉部分切除-环舌骨吻合术(SCPL-CHP)在中晚期喉癌患者治疗中对患者术后嗓音及吞咽功能的影响。方法选取我院耳鼻喉科于2009年1月至2012年2月收治的中晚期喉癌患者45例,随机将其分为SCPL-CHP组(n=23)和HVHL组(n=22),分别给予SCPL-CHP术与喉水平垂直部分切除术治疗,比较两组患者的术后嗓音和吞咽功能。结果两组患者计算机对基频(F0)比较差异无统计学意义(P>0.05),SCPL-CHP组基频微扰(Jitter)jerrer、振幅微扰(Shimmer)、标准化噪声能量(NNE)显著高于HVHL组,差异均有统计学意义(P<0.05或P<0.01);SCPL-CHP组重度声嘶发生率为95.65%,显著高于HVHL组的13.64%,而中度声嘶的发生率仅为4.35%,显著低于HVHL组的86.36%,差异均有统计学意义(P<0.05);SCPL-CHP组中度误咽发生率为65.22%,明显高于HVHL组的36.36%,而轻度误咽的发生率为30.43%,显著低于HVHL组的63.64%,差异均有统计学意义(P<0.05)。两组术后3年生存率比较差异均无统计学意义(P>0.05)。结论总体上,HVHL术式在中晚期喉癌的治疗中,疗效优于SCPL-CHP,但中晚期喉癌患者的治疗应根据肿瘤的生长部位、大小、形态结构、侵及范围、分化程度等情况选择正确的手术方式,在根治肿瘤的基础上尽量保留喉的结构与功能。Objective To discuss the influence of supracricoid partial laryngectomy-cricohyoidopexy（SCPL-CHP） and horizontal-vertical hemilaryngectomy（HVHL） on voice and swallowing function in patients with mid and late stage laryngeal carcinoma. Methods Forty-five patients with mid and late stage laryngeal carcinoma were randomly divided into the SCPL-CHP group（n=23） and the HVHL group（n=22）. The SCPL-CHP group was treated with SCPL-CHP, and the HVHL group was treated with HVHL. Then the voice and swallowing function were compared between the two groups. Results There was no significantly difference in F0 between the two groups（P〈0.05）.Jerrer, shimmer, NNE in the SCPL-CHP group were significantly higher than those in the HVHL group（P〈0.05 or P〈0.01）. The incidence of severe hoarseness was 95.65% in the SCPL-CHP group, significantly higher than 13.64% in the HVHL group（P〈0.01）. The incidence of moderate hoarseness in the HVHL group was 86.36%, significantly higher than 4.35% in the SCPL-CHP group（P〈0.01）. The incidence of moderate aspiration in the SCPL-CHP group was65.22%, significantly higher than 36.36% in the HVHL group（P〈0.05）. The incidence of mild aspiration in the SCPL-CHP group was 30.43%, significantly lower than 63.64% in the SCPL-CHP group（P〈0.05）. There was no significantly difference between the two groups in the survival rate of 3 years（P〉0.05）. Conclusion In overall, the efficacy of HVHL is better than SCPL-CHP in the treatment of mid and late stage laryngeal carcinoma. We should choose a correct operation according to the tumor size, growth location, morphology, violations involving, the degree of differentiation of the tumor in the treatment of patients with mid and late laryngeal carcinoma, in line with the principle of individual, to keep the structure and function of the larynx on the basis of radical tumor retain.

关 键 词：环状软骨舌骨吻合术 喉水平垂直部分切除术 嗓音 吞咽功能 

分 类 号：R739.65[医药卫生—肿瘤]