CAJ | 학술논문

目的探讨保留会厌的声门上和声门区同时受累的喉癌手术方法、修复方式和术后功能状况.方法回顾性分析2005年6月至2010年12月97例会厌正常而声门上、声门区同时受累的喉癌患者,依据2002年UICC分期标准Ⅱ期37例,Ⅲ期41例,Ⅳ期19例.针对不同缺损范围和特点对86例行喉垂直部分切除术(vertical partial laryngectomy,VPL)和扩大喉垂直部分切除术(expanded vertical partial laryngectomy,EVPL),分别进行修复重建；11例行环舌骨会厌固定术(cricohyoidoepiglottopexy,CHEP).术后对喉功能及相关生活质量进行评价.Kaplan-Meier计算生存率.结果全组病例3年、5年生存率为87.1％,69.6％.VPL和EVPL组、CHEP组3年、5年累积生存率为86.6％,68.3％和90.0％,78.8％,两组差异无统计学意义(P＞0.05)；术后总拔管率为88.7％,VPL/EVPL组拔管率为87.2％(75/86),CHEP组100％(11/11),两组差异无统计学意义(P＞0.05).两组平均恢复进食时间(x±s)为(5.2±1.3)d和(15.7 ±5.2)d,CHEP组的时间长于VPL/EVPL组(P＜0.01).CHEP组最大声时较短(Z=3.92,P＜0.01),清浊音比S/Z比值较高(Z=5.01,P＜0.01)；主观听感知GRBAS评分两组对比,G评分和B评分CHEP组要高(Z =4.43,Z=3.37,P＜0.01),R评分对比差异无统计学意义(P＞0.05)；嗓音障碍指数(voice handicap index,VHI) VHI-10评分VPL和EVPL组与CHEP组分别为(29.5 ±4.7)分和(31.6±6.3)分,差异无统计学意义(P＞0.05).结论对于声门上和声门区同时受累而会厌正常的喉癌患者,至少一侧2/3甲状软骨板的保留以及会厌的存在和下移是实施喉垂直部分切除术式、顺利拔管的重要保障.
목적 탐토보류회염적성문상화성문구동시수루적후암수술방법、수복방식화술후공능상황.방법 회고성분석2005년6월지2010년12월97례회염정상이성문상、성문구동시수루적후암환자,의거2002년UICC분기표준Ⅱ기37례,Ⅲ기41례,Ⅳ기19례.침대불동결손범위화특점대86례행후수직부분절제술(vertical partial laryngectomy,VPL)화확대후수직부분절제술(expanded vertical partial laryngectomy,EVPL),분별진행수복중건；11례행배설골회염고정술(cricohyoidoepiglottopexy,CHEP).술후대후공능급상관생활질량진행평개.Kaplan-Meier계산생존솔.결과 전조병례3년、5년생존솔위87.1％,69.6％.VPL화EVPL조、CHEP조3년、5년루적생존솔위86.6％,68.3％화90.0％,78.8％,량조차이무통계학의의(P＞0.05)；술후총발관솔위88.7％,VPL/EVPL조발관솔위87.2％(75/86),CHEP조100％(11/11),량조차이무통계학의의(P＞0.05).량조평균회복진식시간(x±s)위(5.2±1.3)d화(15.7 ±5.2)d,CHEP조적시간장우VPL/EVPL조(P＜0.01).CHEP조최대성시교단(Z=3.92,P＜0.01),청탁음비S/Z비치교고(Z=5.01,P＜0.01)；주관은감지GRBAS평분량조대비,G평분화B평분CHEP조요고(Z =4.43,Z=3.37,P＜0.01),R평분대비차이무통계학의의(P＞0.05)；상음장애지수(voice handicap index,VHI) VHI-10평분VPL화EVPL조여CHEP조분별위(29.5 ±4.7)분화(31.6±6.3)분,차이무통계학의의(P＞0.05).결론 대우성문상화성문구동시수루이회염정상적후암환자,지소일측2/3갑상연골판적보류이급회염적존재화하이시실시후수직부분절제술식、순리발관적중요보장.
Objective To investigate the surgery preserving epiglottis,the repair and the postoperative functions in laryngeal carcinoma involving supraglottic and glottic areas.Methods A total of 97 cases with laryngeal cancer involving both supraglottic and glottic areas with normal epiglottis underwent surgery between June 2005 and December 2010 was reviewed.Of them 37 cases were stage Ⅱ,41 cases were stage Ⅲ,and 19 cases were stage Ⅳ.Vertical partial laryngectomy(VPL) or extended VPL with the repair and functional reconstruction was carried out in 86 cases and cricohyoidoepiglottopexy (CHEP) in 11 cases.Postoperative survival rate,laryngeal functions and quality of life were evaluated.Results The 3-year and 5-year total cumulative survival rate (Kaplan-Meire survival analysis) were 87.1％ and 69.6％ in the 97 cases; 86.6％ and 68.3％ in VPL/EVPL group; 90.0％ and 78.8％ in CHEP group,respectively,with no significant difference between VPL/EVPL and CHEP groups (P ＞ 0.05).Of 97 cases,86(88.7％) cases were decannulated postoperatively.The rates of decannulation were 87.2％ (75/86) in VPL/EVPL group and 100％ (11/11) in CHEP group,with no significant difference (P ＞ 0.05).Average oral diet recovery time of VPL/EVPL group and CHEP group was (5.2 ± 1.3) and (15.7 ±5.2) days,respectively,with a significant difference (P ＜ 0.01).Voice evaluation showed the mean maximum phonation time of VPL/EVPL group was shorter than that of CHEP group (P ＜ 0.01) and the S/Z ratio of VPL/EVPL group was higher than that of CHEP group (P ＜ 0.01).Perceptual voice evaluation GRBAS ratings showed patients in VPL/EVPL group had higher G and B ratings compared to patients in CHEP group (P＜0.01),but no significant difference in R-rating between two groups (P ＞ 0.05).Voice handicap index-10 (VHI-10) scores of VPL/EVPL and CHEP groups were 29.5 ±4.7 and 31.6 ±6.3,respectively,no significant difference (P ＞ 0.05).Conclusions For patients with the laryngeal carcinoma involving both supraglottic and glottic areas,VPL has better anatomical and functional outcomes than CHEP.The preservation of at least 2/3 of the lamina of thyroid cartilage on one side and shift-down of epiglottis were key to successful VPL and postoperative decannulation.