de Vincentiis M, Minni A, Gallo A, Di Nardo A
IV ENT Clinic, University La Sapienza, Rome, Italy.
Head Neck. 1998 Sep;20(6):504-9. doi: 10.1002/(sici)1097-0347(199809)20:6<504::aid-hed3>3.0.co;2-t.
The authors present their study on oncologic and functional results of supracricoid partial laryngectomies (SPL) performed on 149 patients between January 1984 and December 1995.
Cricohyoidopexy (CHP) was carried out on 98 patients and cricohyoidoepiglottopexy (CHEP) on 51 patients. The patients were divided into two groups. The first group included those operated on between January 1984 and December 1992 and who therefore had a minimum follow-up period of 3 years. The second group included those operated on after December 1992 and who therefore had a follow-up period of less than 3 years. The statistical evaluation of this second group was carried out using an actuarial method according to Kaplan-Meier.
In the first group, survival rate (regarding disease-related deaths) was 94% (95/101), whereas in the second group, survival rate was 95%. There were 9 recurrences in the 149 patients (6.71%), B of which occurred after CHP (6 for tumor [T] and 2 for node [N]) and 1 (for T) after CHEP. Three of the 6 recurrences for T after CHP occurred in the hypopharynx, 2 in the peristomal area, and 1 in the arytenoid area. The only recurrence for T after CHEP occurred in the paraglottic area. Decannulation was carried out in 85.7% of CHP patients (84/98) and in 98% of CHEP patients (50/51). The nasogastric tube was kept in position for an average of 28 days (range, 15-90 days) in the CHP patients and 15 days (range, 9-90 days) in the CHEP patients. Swallowing was excellent; only a small number of patients (n = 21) were forced to assume a particular posture during meals. Phoniatric controls performed on 104 patients also showed adequate speech recovery.
If the indications are applied scrupulously, CHEP is a valid alternative to partial laryngeal surgery and CHP is a possible alternative to total laryngectomy in the treatment of glottic and supraglottic tumors.
作者介绍了他们对1984年1月至1995年12月期间149例患者实施环状软骨上部分喉切除术（SPL）的肿瘤学和功能结果的研究。
98例患者实施了环舌骨固定术（CHP），51例患者实施了环舌骨会厌固定术（CHEP）。患者被分为两组。第一组包括1984年1月至1992年12月期间接受手术的患者，因此其最短随访期为3年。第二组包括1992年12月之后接受手术的患者，因此其随访期不到3年。对第二组的统计评估采用根据Kaplan-Meier法的精算方法。
第一组的生存率（与疾病相关的死亡）为94%（95/101），而第二组的生存率为95%。149例患者中有9例复发（6.71%），其中6例发生在CHP术后（肿瘤[T]复发6例，淋巴结[N]复发2例），CHEP术后1例（T复发）。CHP术后T复发的6例中，3例发生在下咽部，2例发生在造口周围区域，1例发生在杓状软骨区域。CHEP术后T的唯一复发发生在声门旁区域。85.7%的CHP患者（84/98）拔管，98%的CHEP患者（50/51）拔管。CHP患者鼻胃管平均留置28天（范围15-90天），CHEP患者鼻胃管平均留置15天（范围9-90天）。吞咽功能良好；只有少数患者（n = 21）在进餐时被迫采取特定姿势。对104例患者进行的语音检查也显示语音恢复良好。
如果严格掌握适应证，CHEP是部分喉手术的有效替代方法，CHP是治疗声门和声门上肿瘤时全喉切除术的一种可能替代方法。
