CAJ | 학술논문

目的扩大垂直半喉切除和传统喉环状软骨上部分切除环舌骨会厌吻合术(cricochyoidoepiglottopexy,CHEP)的疗效和术后评估的比较.方法回顾性分析1998-2005年扩大垂直半喉切除患者和传统喉环状软骨上部分切除环舌骨会厌吻合术式患者临床资料.扩大垂直半喉切除方法为:按类似扩大垂直半喉术式的方法切除健侧声带、室带及1/3至2/3左右的甲状软骨板,保留健侧环杓关节,切除患侧声带、室带、患侧活动受限或固定的杓状软骨及患侧2/3左右甲状软骨板,保留双侧甲状软骨板的后缘,直接将环状软骨上提和舌骨会厌固定吻合.扩大垂直半喉切除组(简称改良组):37例声门型喉癌,T2 16例,T3 21例.传统CHEP组:34例声门型喉癌,T2 12例,T321例,T4 1例.结果 Kaplan-Meier法统计生存率,改良组的3年累积生存率为91.7%,传统CHEP组为87.5%,差异无统计学意义(P>0.05).改良组的5年累积生存率为80.6%,传统CHEP组为81.3%,差异无统计学意义(P>0.05).术后拔管率改良组为100.0%(37/37),传统CHEP组为94.1%(32/34),两组差异无统计学意义(P>0.05).术后拔管平均时间((x-)±s)改良组为(14.0±2.3)d,传统CHEP组为(19.0±4.6)d,两组差异有统计学意义(t=5.80,P<0.001).术后8周评价误咽发生率,改良组为2.7%(1/37),传统CHEP组为23.5%(8/34),两组差异有统计学意义(P<0.05);术后误咽呛咳评分通过Ridit分析,结果表明两组之间差异有统计学意义(U=7.341,P<0.001),改良组误咽呛咳的不适症状明显轻于传统CHEP组.结论扩大垂直半喉切除在肿瘤根治上和传统CHEP术式无差别,而在喉功能保全上优于传统CHEP术式.
목적 확대수직반후절제화전통후배상연골상부분절제배설골회염문합술(cricochyoidoepiglottopexy,CHEP)적료효화술후평고적비교.방법 회고성분석1998-2005년확대수직반후절제환자화전통후배상연골상부분절제배설골회염문합술식환자림상자료.확대수직반후절제방법위:안유사확대수직반후술식적방법절제건측성대、실대급1/3지2/3좌우적갑상연골판,보류건측배표관절,절제환측성대、실대、환측활동수한혹고정적표상연골급환측2/3좌우갑상연골판,보류쌍측갑상연골판적후연,직접장배상연골상제화설골회염고정문합.확대수직반후절제조(간칭개량조):37례성문형후암,T2 16례,T3 21례.전통CHEP조:34례성문형후암,T2 12례,T321례,T4 1례.결과 Kaplan-Meier법통계생존솔,개량조적3년루적생존솔위91.7%,전통CHEP조위87.5%,차이무통계학의의(P>0.05).개량조적5년루적생존솔위80.6%,전통CHEP조위81.3%,차이무통계학의의(P>0.05).술후발관솔개량조위100.0%(37/37),전통CHEP조위94.1%(32/34),량조차이무통계학의의(P>0.05).술후발관평균시간((x-)±s)개량조위(14.0±2.3)d,전통CHEP조위(19.0±4.6)d,량조차이유통계학의의(t=5.80,P<0.001).술후8주평개오인발생솔,개량조위2.7%(1/37),전통CHEP조위23.5%(8/34),량조차이유통계학의의(P<0.05);술후오인창해평분통과Ridit분석,결과표명량조지간차이유통계학의의(U=7.341,P<0.001),개량조오인창해적불괄증상명현경우전통CHEP조.결론 확대수직반후절제재종류근치상화전통CHEP술식무차별,이재후공능보전상우우전통CHEP술식.
Objective To compare the results of extended vertical partial laryngectomy (similar to modified supraericoid partial laryngectomy with cricohyoidoepiglottopexy) and cricohyoidoepiglottopexy in the treatment of laryngeal carcinoma.Methods Retrospectively analyzed on the results and prognosis in pafients underwent extended vertical partial laryngectomy and cricohyoidoepiglottopexy between 1998 and 2005.The operation was similar to extended vertical partial laryngectom.The healthy vocal cord and ventricular band as well as about 1/3 to 2/3 laminas of thyoid cartilage were removed.The healthy cricoarytenoid joint was reserved.The vocal cord,ventricular band,fixed or limitation of motion arytenoid cartilage and 2/3 laminas of thyoid cartilage in ill side were removed.The posteroinferior border of laminas of thyoid cartilage in both sides were reserved.The cricoid was lifted and fixed with hyoid epiglottis directly.Extended vertical partial laryngeetomy group consisted of 37 patients with glottic carcinoma (stage T2 16 cases,stage T3 21 cases) and cricohyoidoepiglottopexy group consisted of 34 patients with glottic carcinoma (stage T2 12 cases,stage T3 21 cases,stage T4 l case) .Results Kaplan-Meier analysis was performed to calculate the survival rates.The three-year cumulative survival rate was 91.7%in extended vertical partial laryngectomy group and 87.5%in cricohyoidoepiglottopexy group respectively.There was no significant difference between the two groups (P>0.05) .The five-year cumulative survival rate was 80.6%in extended vertical partial laryngectomy group and 81.3%in cricohyoidoepiglottopexy group respectively.There was also no significant difference between the two groups (P>0.05) .The decannulation rate was 100% (37/37) in extended vertical partial laryngectomy group and 94.1% (32/34) in cricohyoidoepiglottopexy group respectively.The decannulation time was (14.0±2.3) days in extended vertical partial laryngectomy group and (19.0±4.6) days in cricohyoidoepiglottopoxy group respectively.The incidence of aspiration was 2.7% (1/37) in modified group and 23.5 (8/34) in cricohyoidoepiglottopexy group respectively evaluated at 8th weeks post-operatively.The evaluation of deglutition disorder was analyzed by Ridit analysis in both groups and the results showed that there was significant difference between the two groups (U=7.341,P<0.001) .The symptom of aspiration in extended vertical partial laryngectomy group was significant less than in cricohyoidoepiglottopexy group.Conclusions Although the survival rate was not different between the two groups.The preservation of laryngeal function in extended vertical partial laryngectomy group was significant better than in cricohyoidoepiglottopexy group and extended vertical partial laryngectomy.