[喉癌部分喉切除术的治疗结果]

Pajor Anna, Kopczyński Jerzy, Gryczyński Maciej

Katedra Otolaryngologii UM w Lodzi.

Otolaryngol Pol. 2004;58(4):757-64.

The aim of the study was to retrospectively evaluate the results of treatment for early laryngeal carcinoma in a group of 325 patients who underwent from 1980 to 1997 partial laryngectomies. The most often type of operation was cordectomy--51.1%, then frontolateral/frontoanterior laryngectomy--20.9%, vertical laryngectomy--15.1%, supraglottic horizontal laryngectomy--8%, hemilaryngectomy--4.9%. Estimate of survival time, from surgery to first oncologic failure, was obtained with the life-table method. As a failure we considered local and regional recurrence, distant metastasis, second primary neoplasm and spread of disease. The probability of disease-free survival for all partial laryngectomies reached 81.5%, 79.5% and 60.3% at 3, 5 and over 5 years, respectively. The rates of five-year and over 5 year disease-free survival for each type of operation were: for cordectomy--82.3% and 72.3%, for frontolateral/frontoanterior laryngectomy--74.0% and 45.2%, for vertical laryngectomy--87.6% and 60.6%, for hemilaryngectomy--86.2% and 59.7%, for supraglottic horizontal laryngectomy--53.8% and 29.9%, respectively. The comparison between survival rates, by the log-rank test, revealed statistical difference between supraglottic horizontal laryngectomy and following operations: cordectomy (p < 0.001), vertical laryngectomy (p < 0.01), hemilaryngectomy (p < 0.05). The differences between other types of laryngectomy were not significant statistically. The best results in treatment of laryngeal carcinoma by partial laryngectomies were achieved by operations in vertical plane (cordectomy, vertical laryngectomy and hemilaryngectomy), the less positive--by operations in horizontal plane (supraglottic horizontal laryngectomy).

本研究旨在回顾性评估1980年至1997年间接受部分喉切除术的325例早期喉癌患者的治疗结果。最常施行的手术类型是声带切除术——51.1%，其次是前外侧/额前喉切除术——20.9%，垂直喉切除术——15.1%，声门上水平喉切除术——8%，半喉切除术——4.9%。采用寿命表法估算从手术至首次肿瘤学失败的生存时间。我们将局部和区域复发、远处转移、第二原发性肿瘤及疾病播散视为失败。所有部分喉切除术的无病生存率在3年、5年和5年以上分别达到81.5%、79.5%和60.3%。每种手术类型的5年和5年以上无病生存率分别为：声带切除术——82.3%和72.3%，前外侧/额前喉切除术——74.0%和45.2%，垂直喉切除术——87.6%和60.6%，半喉切除术——86.2%和59.7%，声门上水平喉切除术——53.8%和29.9%。通过对数秩检验比较生存率，结果显示声门上水平喉切除术与以下手术之间存在统计学差异：声带切除术（p<0.001）、垂直喉切除术（p<0.01）、半喉切除术（p<0.05）。其他类型喉切除术之间的差异无统计学意义。部分喉切除术治疗喉癌的最佳结果是通过垂直平面手术（声带切除术、垂直喉切除术和半喉切除术）取得的，而水平平面手术（声门上水平喉切除术）的效果相对较差。