Amatsu M, Makino K, Kinishi M
Auris Nasus Larynx. 1985;12(2):103-10. doi: 10.1016/s0385-8146(85)80007-9.
Out of a total of 340 laryngectomies performed in the Department of Otorhinolaryngology at Kobe University Hospital from 1969 to 1982, there were 20 stomal recurrences. In the preoperative tracheostomy group, 6 out of 52 patients (11.5%) developed stomal recurrence compared to 14 out of 288 (4.9%) in the operative tracheostomy group. Of these 20 stomal recurrences, 7 were supraglottic with 1 subglottic extension, 9 were glottic with 8 subglottic extensions, and 4 were primary subglottic cancers. The mean interval between the laryngectomy and stomal recurrence was 16 months and ranged from 20 days to 55 months after laryngectomy. We analyzed our series together with recent material which had been subjected to pretracheal and paratracheal lymphatic dissection. Reports from the literature were also used. Tumor cell inoculation in the tracheostomy wound and persistent pretracheal and paratracheal lymph node lesion are the two most likely major etiologic factors. The above evaluation leads us to propose the following preventive measures: 1) thorough irrigation of the wound following the removal of the larynx, 2) complete excision of the tracheostomy tract for preoperatively tracheostomized patients, 3) pretracheal and paratracheal lymphatic dissection for subglottic lesion, 4) in the above cases, laryngectomy should be followed by peristomal radiotherapy.
1969年至1982年期间，神户大学医院耳鼻喉科共进行了340例喉切除术，其中有20例出现造口复发。在术前气管切开组中，52例患者中有6例（11.5%）发生造口复发，而手术气管切开组288例中有14例（4.9%）。在这20例造口复发中，7例为声门上型伴1例声门下扩展，9例为声门型伴8例声门下扩展，4例为原发性声门下癌。喉切除术后至造口复发的平均间隔时间为16个月，范围为喉切除术后20天至55个月。我们将我们的系列病例与近期进行了气管前和气管旁淋巴结清扫的资料进行了分析。还使用了文献报道。气管切开伤口处的肿瘤细胞接种以及气管前和气管旁淋巴结持续病变是两个最可能的主要病因。上述评估使我们提出以下预防措施：1）喉切除术后彻底冲洗伤口；2）对术前已行气管切开的患者完整切除气管造口通道；3）对声门下病变进行气管前和气管旁淋巴结清扫；4）在上述情况下，喉切除术后应进行造口周围放疗。
