Huang Zhi-chun, Zhang Feng-bing, Gu Jian-xing, Feng Xu, Sun Bao-bin
Department of Otorhinolaryngology, Zhongda Hospital, Southeast University, Nanjing 210009, China.
Zhonghua Zhong Liu Za Zhi. 2005 Nov;27(11):685-7.
To investigate the therapeutic results after various kinds of partial laryngectomy for patients with glottic carcinoma of the larynx.
From January 1980 to Mar 2004, 98 patients with glottic carcinoma of the larynx were treated by various kinds of partial laryngectomy. The types of operation varied according to stage of the lesion: vertical or frontovertical partial laryngectomy for T1b, T2 and T1a with invasion of anterior commissura, Tuker's operation or supracricoid partial laryngectomy for T1b, T2 or those with invasion of over half of contralateral cord, and extended vertical partial laryngectomy with resection of arytenoids for T3, or with invasion of ipsilateral arytenoids cartilage without involving postcricoid mucosa or posterior commissura. Totally, vertical partial laryngectomy was carried out for 76 patients, extended vertical partial laryngectomy for 7, supracricoid partial laryngectomy for 3 and Tucker's operation for 12. One stage unilateral neck dissection was performed in 5 patients and postoperative radio-therapy was supplemented to 5 (dose 60 Gy). For laryngeal function restoration, pectoro-hyomyo-flap and cricohyoidoepi glotopexy procedures were also performed for some patients. The clinical data of these patients were retrospectively analyzed.
The 3- and 5-year survival rate was 86.5% (64/74) and 81.7% (49/60), respectively. The total decannulation rate was 94.9% (93/98), though fifteen patients had had symptoms of aspiration. Swallowing function of all patients recovered to the normal level. The phonation of all patients was restored to various degrees and they were able to communicate socially.
The 3- and 5-year survival rates of partial laryngectomy for patients with glottic carcinoma of the larynx are comparable to the results achieved by total laryngectomy, but the quality of life of the patents much better. Complete resection of the tumor and simultaneous preservation of respiratory and vocal function whenever possible by partial laryngectomy is very important for improving patients' life quality. With a suitable size and good blood supply, the sternohyoid muscle flap of unipedical and half-thickness instead of whole thickness is ideal in the reconstruction of laryngeal defect after vertical partial laryngectomy.
探讨不同类型部分喉切除术治疗声门型喉癌患者的疗效。
1980年1月至2004年3月，98例声门型喉癌患者接受了不同类型的部分喉切除术。手术方式根据病变分期而异：T1b、T2以及侵犯前联合的T1a患者行垂直或额垂直部分喉切除术；T1b、T2或对侧声带受累超过一半的患者行Tucker手术或环状软骨上部分喉切除术；T3或侵犯同侧杓状软骨但未累及环状软骨后黏膜或后联合的患者行扩大垂直部分喉切除术并切除杓状软骨。其中，76例行垂直部分喉切除术，7例行扩大垂直部分喉切除术，3例行环状软骨上部分喉切除术，12例行Tucker手术。5例患者同期行一期单侧颈清扫术，5例术后补充放疗（剂量60 Gy）。部分患者还采用胸舌骨肌瓣和环状软骨舌骨会厌固定术进行喉功能重建。对这些患者的临床资料进行回顾性分析。
3年和5年生存率分别为86.5%（64/74）和81.7%（49/60）。总拔管率为94.9%（93/98），15例患者有呛咳症状。所有患者吞咽功能均恢复至正常水平。所有患者发音均有不同程度恢复，能够进行社会交流。
声门型喉癌患者行部分喉切除术的3年和5年生存率与全喉切除术相当，但患者生活质量更好。部分喉切除术尽可能完整切除肿瘤并同时保留呼吸和发声功能对提高患者生活质量非常重要。单蒂半厚而非全厚的胸骨舌骨肌瓣大小合适、血供良好，是垂直部分喉切除术后喉缺损修复的理想选择。
