喉癌病人喉部分切除术的远期疗效分析  

An analysis of long-term results of partial laryngectomy

作　　者：李晓明[1] 张慰天[2] 郭晓峰[2] 

机构地区：[1]石家庄白求恩国际和平医院耳鼻咽喉-头颈外科,050082 [2]长春市吉林大学第一医院耳鼻咽喉-头颈外科

出　　处：《耳鼻咽喉（头颈外科）》2002年第6期342-345,共4页Chinese Arch Otolaryngology-Head Neck Surg

摘　　要：目的 :通过对不同类型喉切除术的临床资料进行分析 ,对喉部分切除术与喉全切除术的远期疗效加以比较。方法 :总结了我们近年收治的手术治疗喉癌患者中的 195例 ,根据原发肿瘤的部位和侵及范围 ,对上述 195例患者采取不同方法共施行喉裂开肿瘤切除术 14例 ;声门上水平喉切除 78例 ,其中包括声门上扩大水平喉切除术 2 4例 ;垂直部分喉切除 2 4例 ,其中包括额侧喉部分切除 4例。喉次全切除 31例 ,包括水平垂直喉切除 2 8例 ,环状软骨舌骨会厌固定术 3例 ,喉全切除术 4 8例。上述病例均经 3～ 5年随访。结果 :喉全切除术患者术后 5年整体生存为 79.2 % ,部分喉切除者 5年整体生存为 83.7% ,两组间比较无明显差异。术后癌转移和复发是主要的致死原因。颈淋巴结转移对声门上型喉癌的5年生存率有明显影响。通过施行喉部分切除术 ,所有患者的喉呼吸及发声功能都得到了不同程度的保留。结论 :对喉部分切除术的分类及术式选择实行标准化 ,在彻底切除肿瘤的同时尽可能保全喉功能 ,对提高喉癌手术的治疗效果和患者的生存质量均具有重要意义。Objective: To compare long\|term results of total laryngectomy and various partial laryngectomies in treatment of laryngeal cancer.Method:One hundred ninety\|five patients with laryngeal carcinoma were treated by surgery from January 1993 to December 1996.There were 115 males and 80 females,ranging in age from 36 to 78 years old.Among 195 cases,132 were supraglottic carcinoma (67 7%,132/195),57 were glottic carcinoma (29 2%,57/195)and 6 were subglottic carcinoma(3 1%,6/195).The clinical stages of 195 cases,T 1 were 33(T 1N 0 in 27,T 1N 1 in 6),T 2 were 58(T 2N 0 in 41,T 2N 1 in 9,T 2N 2 in 6 and T 2N 3 in 2),T 3 were 76(T 3N 0 in 42,T 3N 1 in 12,T 3N 2 in 19 and T 3N 3 in 3)and 28 were T 4(T 4N 0 in 10,T 4N 1 in 13,T 4N 2 in 2 and T 4N 3 in 3).Among the various laryngectomies of 195 patients,14 cases were laryngofissure and tumor ablation,78 cases were supraglottic horizontal partial laryngectomie (including 24 cases of extension to supraglottic horizontal partial laryngectomies),24 cases were vertical partial laryngectomies(including 28 cases of horizontal\|vertical laryngectomies and 3 cases of Majior\|Piquet′s operation)and 48 cases were total laryngectomies.All patients were subjected to 5 year postoperative follow\|up.Results:The 5\|year survival rate was 79 2% in the total laryngectomy group and 83 7% in the partial laryngectomy group respectively.Metastasis and recurrence were the two major causes for the postoperative mortality in the present series.Cervical lymph node metastasis has great impacts on the 5\|year postoperative survival in the supraglottic laryngeal cancer patients.Preservation of respiratory and vocal functions was achieved to different extent in the partial laryngectomy patients.Conclusion:Classification and selection of indications for partial laryngectomy should be standardized to achieve good postoperative results in partial laryngectomy patients.

关 键 词：喉癌 喉部分切除术 远期疗效分析 

分 类 号：R739.65[医药卫生—肿瘤]