关键词: 喉癌, 喉部分切除术, 存活率, 生存质量

Abstract:

Background and purpose: Nowadays, about therapy of laryngeal carcinoma, people are paying more and more widely attention to finding out how to improve quality of patients’ life besides radical surgery. For glottis laryngeal carcinoma which invading anterior commissure or bilateral vocal cord, we performed modified frontolateral partial laryngectomy or modified cricohyoidoepiglottopexy, and contrastive analyzed the therapeutic efficacy of the two ways. Methods: Sixty cases patients of glottic laryngeal carcinoma who treated in Hunan Provincial Tumor Hospital during 2005 to 2010, which invaded the anterior commissure or bilateral vocal cord, were randomly attributed to two groups as A and B; 30 patients of group A were underwent modified frontolateral partial laryngectomy and repaired with bilateral sternohyoid muscle flap, 30 patients of group B were treated by modified cricohyoidoepiglottopexy. Followup time of each patient was 5 years postoperation and clinical data were retrospectively analyzed. Results: The 5-year survival rate was 86.7% in group A as well as 83.3% in group B, and there was no statistical difference between two groups (P=0.718). Pronunciation function: 22 cases in group A and 21 cases in group B whose pronunciation function can be competent in the noisy environment, and can pronounce “a” and “i” vowel; 8 cases in group A and 9 cases in group B can pronounce only a “ha”, “hi” sound, that couldn’t communicate with others in a noisy environment. There was no statistical difference in pronunciation function between the two groups (P=0.774). Incidence of deglutition disorder 4 weeks postoperation: group A was 0 (0/30), group B was 16.7% (5/30), and the difference between the two groups was statistically significant (P=0.026); average time of extubation postoperation: group A was (10±2.3) d, group B was (20±4.6)d, and the difference between the two groups was statistically significant (P=0.0000); recurrence rate of dyspnea after extubation: group A was 16.7% (5/30), group B was 0 (0/30), and there was statistically significant difference between the two groups (P=0.026). Conclusion: For the glottic laryngeal carcinoma which invading anterior commissure or bilateral vocal cord, there was no statistical difference in 5-years survival rate and function of pronunciation between modified frontolateral partial laryngenctomy and modified cricohyoidoepiglottopexy postoperation. The former had less postoperative deglution disorder, earlier extubation time, and to some extent, alleviated the suffering of the patients, but part of these patients needed secondary surgery due to dyspnea which resulted by radioactive tissue adhesion after extubation. The latter had more serious deglution disorder postoperation, longer recovery time, and relatively longer time to extubating, showed no again dyspnea after extubation, and had more extensive adaptation disease. In a word, each way of operation has its advantage respectively.

Key words: Laryngeal, Partial laryngectomy, Survival, Quality of life