中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2013年
11期
924-929
,共6页
金童%潘新良%雷大鹏%刘大昱%夏明%魏东敏%钱晔%孙睿杰%解光
金童%潘新良%雷大鵬%劉大昱%夏明%魏東敏%錢曄%孫睿傑%解光
금동%반신량%뢰대붕%류대욱%하명%위동민%전엽%손예걸%해광
喉肿瘤%癌,鳞状细胞%喉切除术%修复外科手术%外科皮瓣
喉腫瘤%癌,鱗狀細胞%喉切除術%脩複外科手術%外科皮瓣
후종류%암,린상세포%후절제술%수복외과수술%외과피판
Laryngeal neoplasms%Carcinoma,squamous cell%Laryngectomy%Reconstructive surgical procedures%Surgical flaps
目的 总结晚期喉鳞状细胞癌手术切除与喉功能重建的经验.方法 回顾性分析2000至2010年间238例晚期喉癌患者手术治疗的效果.其中T3 168例,T4 70例；声门型118例,声门上型103例,声门下型3例,复发病例14例；临床分期Ⅲ期145例,Ⅳ期93例；N0 134例,N1 64例,N2 38例,N3 2例.根据肿瘤侵犯的范围,在保证肿瘤安全切缘的前提下采用保留喉功能的喉部分切除术或不保留功能的喉全切除术.生存率统计采用Kaplan-Meier法.结果 238例患者中行喉全切除96例,行喉功能保留手术142例,喉功能保留率59.7％.保留喉功能的患者中90例拔除气管套管,拔管率63.4％.全部患者均成功恢复经口进食,均可以发音.238例患者总的3年及5年生存率分别为81.4％和59.5％,喉功能保留组的3年及5年生存率分别为82.9％和64.3％,喉功能不保留组的3年及5年生存率分别为79.2％和52.4％,两组间比较差异无统计学意义(x2=2.478,P=0.115).结论 通过详细的术前评估、选择合适的手术方式及细致熟练的手术技巧,晚期喉癌患者也有可能保留喉功能.
目的 總結晚期喉鱗狀細胞癌手術切除與喉功能重建的經驗.方法 迴顧性分析2000至2010年間238例晚期喉癌患者手術治療的效果.其中T3 168例,T4 70例；聲門型118例,聲門上型103例,聲門下型3例,複髮病例14例；臨床分期Ⅲ期145例,Ⅳ期93例；N0 134例,N1 64例,N2 38例,N3 2例.根據腫瘤侵犯的範圍,在保證腫瘤安全切緣的前提下採用保留喉功能的喉部分切除術或不保留功能的喉全切除術.生存率統計採用Kaplan-Meier法.結果 238例患者中行喉全切除96例,行喉功能保留手術142例,喉功能保留率59.7％.保留喉功能的患者中90例拔除氣管套管,拔管率63.4％.全部患者均成功恢複經口進食,均可以髮音.238例患者總的3年及5年生存率分彆為81.4％和59.5％,喉功能保留組的3年及5年生存率分彆為82.9％和64.3％,喉功能不保留組的3年及5年生存率分彆為79.2％和52.4％,兩組間比較差異無統計學意義(x2=2.478,P=0.115).結論 通過詳細的術前評估、選擇閤適的手術方式及細緻熟練的手術技巧,晚期喉癌患者也有可能保留喉功能.
목적 총결만기후린상세포암수술절제여후공능중건적경험.방법 회고성분석2000지2010년간238례만기후암환자수술치료적효과.기중T3 168례,T4 70례；성문형118례,성문상형103례,성문하형3례,복발병례14례；림상분기Ⅲ기145례,Ⅳ기93례；N0 134례,N1 64례,N2 38례,N3 2례.근거종류침범적범위,재보증종류안전절연적전제하채용보류후공능적후부분절제술혹불보류공능적후전절제술.생존솔통계채용Kaplan-Meier법.결과 238례환자중행후전절제96례,행후공능보류수술142례,후공능보류솔59.7％.보류후공능적환자중90례발제기관투관,발관솔63.4％.전부환자균성공회복경구진식,균가이발음.238례환자총적3년급5년생존솔분별위81.4％화59.5％,후공능보류조적3년급5년생존솔분별위82.9％화64.3％,후공능불보류조적3년급5년생존솔분별위79.2％화52.4％,량조간비교차이무통계학의의(x2=2.478,P=0.115).결론 통과상세적술전평고、선택합괄적수술방식급세치숙련적수술기교,만기후암환자야유가능보류후공능.
Objective To explore the surgical methods for advanced laryngeal cancer and long term effects of larygectomy.Methods Two hundred and thirty-eight cases of laryngeal cancer at different stages,including 103 cases with supraglottic cancer,118 cases with glottic cancer,3 cases with subglottic cancer,and 14 cases with recurrent cancer,underwent different kinds of operation from 2000 to 2010.The TNM classifications were as follows:T3 168 cases,T4 70 cases.Stage Ⅲ 145 cases,Stage Ⅳ 93 cases.N0 134 cases,N1 64 cases,N2 38 cases,and N3 2 cases.The effects of operation,especially with the preservation of laryngeal function,was analyzed.The disease-free survival rate was calculated by Kaplan-Meier methods.Results Partial laryngectomy was performed on 142 of the 238 cases (59.7％).Total laryngectomy was performed on 96 cases.In 142 patients who received partial laryngectomy with preservation of laryngeal function,the trachea cannula was extracted in 90 patients,with the decanulation rate as 63.4％.The nasal feeding tube was removed and peroral feeding was recovered in all patients.The patients undergoing partial laryngectomy succeeded in phonation.The 3 years and 5 years disease-free survival rates in all patients were 81.4％ and 59.5％.The 3 years and 5 years disease-free survival rate of partial laryngectomy were 82.9％ and 64.3％.The 3 years and 5 years disease-free survival rates in total laryngectomy were 79.2％ and 52.4％.There was no significantly different between the two groups (x2 =2.478,P =0.115).Conclusion For the advanced laryngeal cancer,it is possible to preserve the laryngeal function without compromising the remote survival rate by detailed pre-operational estimation,properly selected operation and skilled surgical practice.
