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[部分手术作为喉癌功能保留策略的当前作用]

[The current role of partial surgery as a strategy for functional preservation in laryngeal carcinoma].

作者信息

Rodrigo Juan Pablo, Coca-Pelaz Andrés, Suárez Carlos

机构信息

Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Principado de Asturias, España.

出版信息

Acta Otorrinolaringol Esp. 2011 May-Jun;62(3):231-8. doi: 10.1016/j.otorri.2010.06.002. Epub 2010 Aug 3.

Abstract

With the current advances and recent organ preservation protocols for intermediate or advanced stage laryngeal cancer, based on chemotherapy, the role of surgery seemed replaced except for surgical rescue of tumours not responding to these treatments, total laryngectomy being the surgical option. This type of non-surgical treatment is offered as a strategy for organ preservation, as opposed to total laryngectomy. However, we believe that there are two organ-preservation strategies, surgical and non-surgical. A wide spectrum of surgical techniques is available and such techniques lead to excellent results, both oncological and functional (speech and swallowing). The aim of this paper is to present options for organ-preserving surgery for laryngeal cancer. A review of surgical techniques available for functional preservation in cancer of the larynx at intermediate or advanced stage is presented. In addition to classic approaches such as vertical partial laryngectomy and horizontal or supraglottic laryngectomy, options for conservative laryngeal surgery have improved significantly over the past two decades. Minimally invasive surgery, transoral laser surgery, and supracricoid partial laryngectomy have become important laryngeal preservation approaches for patients with laryngeal cancer. Surgery must define its role in the multidisciplinary treatment of advanced cancers of the larynx, which at present often favours (chemo)radiotherapy protocols.

摘要

随着目前基于化疗的中晚期喉癌治疗进展和近期器官保存方案的出现,除了对这些治疗无反应的肿瘤进行手术挽救(全喉切除术为手术选择)外,手术的作用似乎已被取代。这种非手术治疗作为一种器官保存策略被提供,与全喉切除术相反。然而,我们认为存在两种器官保存策略,即手术和非手术策略。有多种手术技术可供选择,这些技术在肿瘤学和功能方面(言语和吞咽)都能产生优异的效果。本文旨在介绍喉癌器官保留手术的选择。本文对中晚期喉癌功能保留可用的手术技术进行了综述。除了垂直部分喉切除术、水平或声门上喉切除术等经典方法外,在过去二十年中,保守性喉手术的选择有了显著改善。微创手术、经口激光手术和环状软骨上部分喉切除术已成为喉癌患者重要的喉保留方法。手术必须明确其在晚期喉癌多学科治疗中的作用,目前晚期喉癌的多学科治疗往往倾向于(化疗)放疗方案。

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