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保留喉功能的前外侧垂直部分喉切除术(FLVPL)治疗累及前连合且与甲状软骨粘连的 T4a 声门型喉癌:一种创新性尝试。

Laryngeal function-preserving of frontolateral vertical partial laryngectomy (FLVPL) for selected T4a glottic cancer with thyroid cartilage invasion adherence to the anterior commissure: an innovative attempt.

机构信息

State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, China.

Department of Breast Surgery, Panyu Central Hospital, Guangzhou, China.

出版信息

Eur Arch Otorhinolaryngol. 2022 Dec;279(12):5735-5740. doi: 10.1007/s00405-022-07459-8. Epub 2022 Jun 9.

Abstract

OBJECTIVE

To evaluate the feasibility and efficacy in selected T4a glottic cancer (thyroid cartilage invasion adherence to the anterior commissure) treated with frontolateral vertical partial laryngectomy (FLVPL) and laryngeal framework reconstruction using titanium mesh.

METHODS

Six patients with the limited T4a glottic cancer with thyroid cartilage destruction adherence to the anterior commissure, underwent FLVPL from 2009 to 2016 in Sun Yat-Sen University Cancer Center. All patients were followed up postoperatively.

RESULTS

All patients comprised radical tumor resection and favorable functional outcomes, and no aspiration and laryngeal stenosis were observed. According to postoperative pathology, four patients should go through postsurgical radiotherapy with a mean dose of 66 Gy. But one of them refused to undergo postoperative radiotherapy, who observed local recurrence in postcricoid area underwent total laryngectomy (TL) and ipsilateral selected neck dissection in post-surgery two year. During follow-up period, all patients were still alive, and five patients without local recurrence and distant metastases.

CONCLUSION

FLVPL and laryngeal framework reconstruction using titanium mesh is one viable surgical procedure to obtain adequate oncologic and functional outcomes.

摘要

目的

评估采用前外侧垂直部分喉切除术(FLVPL)联合钛网喉框架重建术治疗局限于 T4a 声门型喉癌(侵犯并黏附前联合的甲状软骨)的可行性和疗效。

方法

中山大学肿瘤防治中心 2009 年至 2016 年期间对 6 例局限于 T4a 声门型喉癌且侵犯并黏附前联合的甲状软骨的患者施行 FLVPL,所有患者术后均进行随访。

结果

所有患者均达到肿瘤根治性切除和良好的功能效果,无吸入和喉狭窄发生。根据术后病理,4 例患者需行术后放疗,平均剂量为 66Gy。但其中 1 例患者拒绝行术后放疗,2 年后在环后区观察到局部复发,行全喉切除术(TL)和同侧选择性颈淋巴结清扫术。随访期间,所有患者均存活,5 例患者无局部复发和远处转移。

结论

FLVPL 联合钛网喉框架重建术是一种可行的手术方法,可获得足够的肿瘤学和功能学效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c32a/9649462/f5d61ad4deeb/405_2022_7459_Fig1_HTML.jpg

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