Nakayama Meijin, Okamoto Makito, Hayakawa Kazushige, Ishiyama Hiromichi, Kotani Shouko, Miyamoto Shunsuke, Seino Yutomo, Okamoto Tabito, Soda Itaru, Sekiguchi Akane
Department of Otorhinolaryngology, Kitasato University School of Medicine, Kanagawa 252-0374, Japan.
Auris Nasus Larynx. 2013 Apr;40(2):207-10. doi: 10.1016/j.anl.2012.07.014. Epub 2012 Aug 11.
A history of radiation therapy is known to be a major risk factor promoting post-surgical complications. By comparing the clinical outcomes of supracricoid laryngectomy with cricohyoidoepiglottopexy (SCL-CHEP) in irradiated and non-irradiated patients, we investigated the usefulness of salvage SCL-CHEP.
73 patients who received SCL-CHEP between 1997 and 2010 (30 had received radiation therapy preoperatively and 43 had not). Staging error, wound infection, accuracy of surgical margin determination, acquired laryngeal function, and prognosis were compared between the two groups.
Staging error occurred in 6/30 (20%) irradiated and 14/43 (33%) non-irradiated patients. An intraoperative margin study demonstrated a dysplastic or positive margin in 15/30 (50%) irradiated and 13/43 (30%) non-irradiated patients. Wound infection developed in 12/30 (40%) irradiated and 7/43 (16%) non-irradiated patients (P<0.05). Delayed wound infection was identified in four patients with a radiation dose over 65Gy. Swallowing function (ability to eat in public) was acquired in 28/30 (93%) irradiated and 39/43 (91%) non-irradiated patients. Five-year larynx preservation rates were 94% in irradiated and 91% in non-irradiated patients. Five-year overall survival rates were 81% in irradiated and 87% in non-irradiated patients.
Risk of infection was significantly higher in irradiated patients; delayed infection should be appropriately managed. Functional and oncological results were stable regardless of radiation history. We encourage head and neck surgeons to take reasonable risks in performing salvage SCL-CHEP.
放射治疗史是促进术后并发症的主要危险因素。通过比较接受过放疗和未接受过放疗的患者行环状软骨上喉切除术联合环状软骨舌骨会厌固定术（SCL-CHEP）的临床结果，我们研究了挽救性SCL-CHEP的有效性。
1997年至2010年间接受SCL-CHEP的73例患者（30例术前接受过放射治疗，43例未接受过放射治疗）。比较两组的分期误差、伤口感染、手术切缘判定的准确性、获得的喉功能和预后。
6/30（20%）接受放疗的患者和14/43（33%）未接受放疗的患者出现分期误差。术中切缘研究显示，15/30（50%）接受放疗的患者和13/43（30%）未接受放疗的患者切缘发育异常或阳性。12/30（40%）接受放疗的患者和7/43（16%）未接受放疗的患者发生伤口感染（P<0.05）。4例放射剂量超过65Gy的患者出现延迟伤口感染。28/30（93%）接受放疗的患者和39/43（91%）未接受放疗的患者获得吞咽功能（在公共场合进食的能力）。接受放疗患者的5年喉保留率为94%，未接受放疗患者为91%。接受放疗患者的5年总生存率为81%，未接受放疗患者为87%。
接受放疗的患者感染风险显著更高；应适当处理延迟感染。无论放疗史如何，功能和肿瘤学结果均稳定。我们鼓励头颈外科医生在进行挽救性SCL-CHEP时承担合理风险。
