Nakayama Meijin, Okamoto Makito, Miyamoto Syunsuke, Takeda Masahiko, Yokobori Satoru, Masaki Takashi, Seino Yutomo
Department of Otorhinolaryngology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan.
Auris Nasus Larynx. 2008 Mar;35(1):77-82. doi: 10.1016/j.anl.2007.04.018. Epub 2007 Sep 14.
Supracricoid laryngectomy (SCL) with Cricohyoidoepiglotto-pexy (CHEP) or Cricohyoido-pexy (CHP) is an organ preservation surgery indicated for early and selected advanced laryngeal cancers. To verify the clinical usefulness of supracricoid laryngectomy versus total laryngectomy, a retrospective review was conducted.
We summarized the clinical and postoperative data of 32 patients who received SCL over the past 9 years (1997-2005). Five-year survival rate of the SCL patient group (29 cases) was compared with that of the patient group receiving total laryngectomy (35 cases) within the same period.
Wound infection was detected in 12 patients (38%). Those with severe infection, which required surgical intervention, included two cases of ruptured pexis and two cases showing cricoid cartilage necrosis induced by Forestier disease. There were two T4 cases that resulted in extensive excision. In one case, excision involved the posterior part of the cricoid cartilage resulting in insufficient closure of the neoglottis; the patient received total laryngectomy 30 months after SCL-CHEP because of persistent aspiration of liquid diet. In the other T4 case, the tumor invaded the thyroid and arytenoid cartilages but not the cricoid cartilage. Reposition of the remaining corniculate cartilage resulted in sufficient closure of the neoglottis; this patient subsequently acquired satisfactory laryngeal function. The 5-year overall survival rate was 86% for SCL group and 61% for the total laryngectomy group (limited to Stages III and IV glottic cancers). The causes of the four deaths were distant metastasis, neck metastasis, and intercurrent disease, respectively. Two patients are alive with distant disease.
Through our experience in this series, the functional and oncological results of SCL showed certain advantages over those of total laryngectomy. Particularly, the clinical impact of SCL-CHEP was impressive; this technique needs is recommended to both head and neck surgeons and patients.
环状软骨上喉切除术（SCL）联合环舌会厌固定术（CHEP）或环舌固定术（CHP）是一种适用于早期及部分进展期喉癌的器官保留手术。为验证环状软骨上喉切除术与全喉切除术的临床实用性，我们进行了一项回顾性研究。
我们总结了过去9年（1997 - 2005年）接受SCL手术的32例患者的临床及术后数据。将SCL患者组（29例）的5年生存率与同期接受全喉切除术的患者组（35例）进行比较。
12例患者（38%）出现伤口感染。严重感染需手术干预的患者中，包括2例固定术破裂及2例因Forestier病导致环状软骨坏死的病例。有2例T4期病例导致广泛切除。其中1例，切除涉及环状软骨后部，导致新声门闭合不全；该患者在SCL - CHEP术后30个月因持续流食误吸接受了全喉切除术。另一例T4期病例中，肿瘤侵犯甲状腺和杓状软骨，但未侵犯环状软骨。剩余小角软骨复位后新声门闭合良好；该患者随后获得了满意的喉功能。SCL组5年总生存率为86%，全喉切除术组（仅限于III期和IV期声门癌）为61%。4例死亡原因分别为远处转移、颈部转移和并发疾病。2例患者带远处疾病存活。
通过我们在本系列研究中的经验，SCL在功能和肿瘤学结果方面显示出优于全喉切除术的某些优势。特别是，SCL - CHEP的临床效果令人印象深刻；该技术值得推荐给头颈外科医生和患者。
