CAJ | 학술논문

背景与目的：当今对于喉癌的治疗，在根治性手术的基础上，如何提高患者术后的生存质量得到越来越广泛的重视。本研究对累及前联合或双侧声带的声门型喉癌进行改良喉垂直前位部分切除或改良环状软骨会厌舌骨吻合术(cricohyoidoepiglottopexy，CHEP)，并对两种手术方式的疗效进行对比评估。方法：将中南大学湘雅医学院附属肿瘤医院头颈二科2005-2007年累及前联合或双侧声带的声门型喉癌60例患者随机交替归入A、B两组，A组30例患者采用改良喉垂直前位部分切除+双侧胸骨舌骨肌瓣修复手术，B组30例患者采用改良CHEP手术。5年内定期随访并进行回顾性分析。结果：5年生存率A组为86.7%，B组为83.3%，差异无统计学意义(P=0.718)。发音功能：可胜任嘈杂环境交流，并能发出“a”、“i”等元音的A组22例(22/30)，B组21例(21/30)；仅能发出“ha”、“hi”等音，不能胜任嘈杂环境交流的A组8例(8/30)，B组9例(9/30)，两组差异无统计学意义(P=0.774)。4周复查误咽发生率：A组为0(0/30)，B组为16.7%(5/30)，两组差异有统计学意义(P=0.026)；术后拔管平均时间A组为(10.0±2.3)d，B组为(20.0±4.6)d，两组差异有统计学意义(P=0.0000)；拔管后再次出现呼吸困难A组为16.7%(5/30)，B组为0(0/30)，两组差异有统计学意义(P=0.026)。结论：对累及前联合或双侧声带的声门型喉癌，改良喉垂直前位部分切除+双侧胸骨舌骨肌瓣修复术和改良CHEP手术在5年生存率、术后发音效果无统计学差异。前者术后误咽小，拔管时间早，一定程度上减轻了患者的痛苦，但部分患者拔管后因放疗后组织粘连等因素导致呼吸困难需再次住院手术；后者术后误咽相对重，恢复时间长，拔管平均时间相对长，但拔管后不会再次出现呼吸困难，并且手术的适应证更加广泛。两种术式各有优势。揹景與目的：噹今對于喉癌的治療，在根治性手術的基礎上，如何提高患者術後的生存質量得到越來越廣汎的重視。本研究對纍及前聯閤或雙側聲帶的聲門型喉癌進行改良喉垂直前位部分切除或改良環狀軟骨會厭舌骨吻閤術(cricohyoidoepiglottopexy，CHEP)，併對兩種手術方式的療效進行對比評估。方法：將中南大學湘雅醫學院附屬腫瘤醫院頭頸二科2005-2007年纍及前聯閤或雙側聲帶的聲門型喉癌60例患者隨機交替歸入A、B兩組，A組30例患者採用改良喉垂直前位部分切除+雙側胸骨舌骨肌瓣脩複手術，B組30例患者採用改良CHEP手術。5年內定期隨訪併進行迴顧性分析。結果：5年生存率A組為86.7%，B組為83.3%，差異無統計學意義(P=0.718)。髮音功能：可勝任嘈雜環境交流，併能髮齣“a”、“i”等元音的A組22例(22/30)，B組21例(21/30)；僅能髮齣“ha”、“hi”等音，不能勝任嘈雜環境交流的A組8例(8/30)，B組9例(9/30)，兩組差異無統計學意義(P=0.774)。4週複查誤嚥髮生率：A組為0(0/30)，B組為16.7%(5/30)，兩組差異有統計學意義(P=0.026)；術後拔管平均時間A組為(10.0±2.3)d，B組為(20.0±4.6)d，兩組差異有統計學意義(P=0.0000)；拔管後再次齣現呼吸睏難A組為16.7%(5/30)，B組為0(0/30)，兩組差異有統計學意義(P=0.026)。結論：對纍及前聯閤或雙側聲帶的聲門型喉癌，改良喉垂直前位部分切除+雙側胸骨舌骨肌瓣脩複術和改良CHEP手術在5年生存率、術後髮音效果無統計學差異。前者術後誤嚥小，拔管時間早，一定程度上減輕瞭患者的痛苦，但部分患者拔管後因放療後組織粘連等因素導緻呼吸睏難需再次住院手術；後者術後誤嚥相對重，恢複時間長，拔管平均時間相對長，但拔管後不會再次齣現呼吸睏難，併且手術的適應證更加廣汎。兩種術式各有優勢。
배경여목적：당금대우후암적치료，재근치성수술적기출상，여하제고환자술후적생존질량득도월래월엄범적중시。본연구대루급전연합혹쌍측성대적성문형후암진행개량후수직전위부분절제혹개량배상연골회염설골문합술(cricohyoidoepiglottopexy，CHEP)，병대량충수술방식적료효진행대비평고。방법：장중남대학상아의학원부속종류의원두경이과2005-2007년루급전연합혹쌍측성대적성문형후암60례환자수궤교체귀입A、B량조，A조30례환자채용개량후수직전위부분절제+쌍측흉골설골기판수복수술，B조30례환자채용개량CHEP수술。5년내정기수방병진행회고성분석。결과：5년생존솔A조위86.7%，B조위83.3%，차이무통계학의의(P=0.718)。발음공능：가성임조잡배경교류，병능발출“a”、“i”등원음적A조22례(22/30)，B조21례(21/30)；부능발출“ha”、“hi”등음，불능성임조잡배경교류적A조8례(8/30)，B조9례(9/30)，량조차이무통계학의의(P=0.774)。4주복사오인발생솔：A조위0(0/30)，B조위16.7%(5/30)，량조차이유통계학의의(P=0.026)；술후발관평균시간A조위(10.0±2.3)d，B조위(20.0±4.6)d，량조차이유통계학의의(P=0.0000)；발관후재차출현호흡곤난A조위16.7%(5/30)，B조위0(0/30)，량조차이유통계학의의(P=0.026)。결론：대루급전연합혹쌍측성대적성문형후암，개량후수직전위부분절제+쌍측흉골설골기판수복술화개량CHEP수술재5년생존솔、술후발음효과무통계학차이。전자술후오인소，발관시간조，일정정도상감경료환자적통고，단부분환자발관후인방료후조직점련등인소도치호흡곤난수재차주원수술；후자술후오인상대중，회복시간장，발관평균시간상대장，단발관후불회재차출현호흡곤난，병차수술적괄응증경가엄범。량충술식각유우세。
Background and purpose:Nowadays, about therapy of laryngeal carcinoma, people are paying more and more widely attention to ifnding out how to improve quality of patients’ life besides radical surgery. For glottic laryngeal carcinoma which invading anterior commissure or bilateral vocal cord, we performed modiifed frontolateral partial laryngectomy or modiifed cricohyoidoepiglottopexy, and contrastive analyzed the therapeutic efifcacy of the two ways. Methods:Sixty cases patients of glottic laryngeal carcinoma who treated in Hunan Provincial Tumor Hospital during 2005 to 2010, which invaded the anterior commissure or bilateral vocal cord, were randomly attributed to two groups as A and B;30 patients of group A were underwent modiifed frontolateral partial laryngectomy and repaired with bilateral sternohyoid muscle lfap, 30 patients of group B were treated by modiifed cricohyoidoepiglottopexy. Follow-up time of each patient was 5 years postoperation and clinical data were retrospectively analyzed. Results:The 5-year survival rate was 86.7%in group A as well as 83.3%in group B, and there was no statistical difference between two groups (P=0.718). Pronunciation function:22 cases in group A and 21 cases in group B whose pronunciation function can be competent in the noisy environment, and can pronounce“a”and“i”vowel;8 cases in group A and 9 cases in group B can pronounce only a“ha”,“hi”sound, that couldn’t communicate with others in a noisy environment. There was no statistical difference in pronunciation function between the two groups (P=0.774). Incidence of deglutition disorder 4 weeks postoperation:group A was 0 (0/30), group B was 16.7%(5/30), and the difference between the two groups was statistically signiifcant (P=0.026);average time of extubation postoperation:group A was (10±2.3) d, group B was (20±4.6)d, and the difference between the two groups was statistically signiifcant (P=0.0000);recurrence rate of dyspnea after extubation:group A was 16.7%(5/30), group B was 0 (0/30), and there was statistically signiifcant difference between the two groups (P=0.026). Conclusion: For the glottic laryngeal carcinoma which invading anterior commissure or bilateral vocal cord, there was no statistical difference in 5-years survival rate and function of pronunciation between modified frontolateral partial laryngenctomy and modified cricohyoidoepiglottopexy postoperation. The former had less postoperative deglution disorder, earlier extubation time, and to some extent, alleviated the suffering of the patients, but part of these patients needed secondary surgery due to dyspnea which resulted by radioactive tissue adhesion after extubation. The latter had more serious deglution disorder postoperation, longer recovery time, and relatively longer time to extubating, showed no again dyspnea after extubation, and had more extensive adaptation disease. In a word, each way of operation has its advantage respectively.