Xu W, Lyu Z H, Ma J K, Tian J J, Feng S H, Cui P, Sa N
Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong Provincial ENT Hospital Affiliated to Shandong University, Jinan 250022, China.
Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong Provincial ENT Hospital Affiliated to Shandong University, Jinan 250022, China; Key Laboratory of Otorhinolaryngology, National Health Commission (Shandong University), Jinan 250012, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 May 7;54(5):339-342. doi: 10.3760/cma.j.issn.1673-0860.2019.05.005.
To evaluate the oncologic and functional outcomes of laryngeal squamous cell carcinomas treated by supracricoid laryngectomy. The clinical data of 134 patients with laryngeal cancer who underwent supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) between July 2005 and April 2014 at Shandong Provincial ENT Hospital were retrospectively reviewed. Ninety-one patients including 31 cases of stage Ⅰ, 36 of stage Ⅱ, 18 of stage Ⅲ and 6 of stage Ⅳ underwent CHEP and 43 patients underwent CHP. Two patients received CHEP due to recurrence after open surgery and laser surgery. Three patients received CHP due to the recurrence of disease after open surgery and postradiotherapy persistence of disease. The Kaplan-Meier method was used to calculate the 3-year and 5-year survival rates. The Chi-square test was used to compare the survival rates between different surgical procedures. All 91 patients who underwent CHEP had successful removals of PEG tubes, and 88 (96.7%) of them had tracheostomy tube decannulation. Among 43 patients with CHP, 42(97.6%) cases removal of PEG tubes(97.6%), including and 40(93.0%) cases with tracheostomy tube decannulation. There was one patient with local recurrence in all cases. In CHEP group, 3-year local control rate was 98.2%; 3-year and 5-year overall survival rate were 94.5% and 93.9%, respectively. In CHP group, 3-year local control rate was 97.6%; 3-year and 5-year overall survival rates were 86.0% and 83.3%, respectively. Pharyngeal fistula appeared in 2 cases of CHEP group and 4 cases of CHP group, and all of them were cured by conservative treatment. Supracricoid laryngectomy shows excellent oncologic and functional results for treatment of laryngeal cancer while maintaining laryngeal functions, especially in terms of local control rate and tracheostomy tube decannulation.
评估环状软骨上喉切除术治疗喉鳞状细胞癌的肿瘤学及功能学疗效。回顾性分析2005年7月至2014年4月在山东省耳鼻喉医院接受环状软骨上喉切除术联合环舌会厌固定术(CHEP)或环舌固定术(CHP)的134例喉癌患者的临床资料。91例患者接受CHEP,包括Ⅰ期31例、Ⅱ期36例、Ⅲ期18例、Ⅳ期6例;43例患者接受CHP。2例患者因开放手术和激光手术后复发接受CHEP。3例患者因开放手术后疾病复发及放疗后疾病持续存在接受CHP。采用Kaplan-Meier法计算3年和5年生存率。采用卡方检验比较不同手术方式的生存率。所有91例行CHEP的患者均成功拔除胃造瘘管,其中88例(96.7%)成功拔除气管套管。43例行CHP的患者中,42例(97.6%)成功拔除胃造瘘管,40例(93.0%)成功拔除气管套管。所有病例中有1例局部复发。CHEP组3年局部控制率为98.2%;3年和5年总生存率分别为94.5%和93.9%。CHP组3年局部控制率为97.6%;3年和5年总生存率分别为86.0%和83.3%。CHEP组有2例出现咽瘘,CHP组有4例出现咽瘘,均经保守治疗治愈。环状软骨上喉切除术在治疗喉癌时能取得良好的肿瘤学及功能学疗效,同时保留喉功能,尤其是在局部控制率和气管套管拔除方面。