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中南大学湘雅医学院附属肿瘤医院头颈二科,湖南,长沙,410013
Published Online:03 March 2014,
Published:2013
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田皞,喻建军,李赞,周晓,戴杰. 改良喉垂直前位部分切除与改良环状软骨会厌舌骨吻合术疗效评估[J]. 中国癌症杂志, 2013, 23(7): 535-539.
田皞, 喻建军, 李赞, et al. Curative effect evaluation between improved frontolateral partial laryngectomy and improved cricohyoidoepiglottopexy[J]. China Oncology, 2013, 23(7): 535-539.
田皞,喻建军,李赞,周晓,戴杰. 改良喉垂直前位部分切除与改良环状软骨会厌舌骨吻合术疗效评估[J]. 中国癌症杂志, 2013, 23(7): 535-539. DOI: 10.3969/j.issn.1007-3969.2013.07.010.
田皞, 喻建军, 李赞, et al. Curative effect evaluation between improved frontolateral partial laryngectomy and improved cricohyoidoepiglottopexy[J]. China Oncology, 2013, 23(7): 535-539. DOI: 10.3969/j.issn.1007-3969.2013.07.010.
背景与目的:当今对于喉癌的治疗,在根治性手术的基础上,如何提高患者术后的生存质量得到越来越广泛的重视。本研究对累及前联合或双侧声带的声门型喉癌进行改良喉垂直前位部分切除或改良环状软骨会厌舌骨吻合术(cricohyoidoepiglottopexy,CHEP),并对两种手术方式的疗效进行对比评估。方法:将中南大学湘雅医学院附属肿瘤医院头颈二科2005—2007年累及前联合或双侧声带的声门型喉癌60例患者随机交替归入A、B两组,A组30例患者采用改良喉垂直前位部分切除+双侧胸骨舌骨肌瓣修复手术,B组30例患者采用改良CHEP手术。5年内定期随访并进行回顾性分析。结果:5年生存率A组为86.7%,B组为 83.3%,差异无统计学意义(P=0.718)。发音功能:可胜任嘈杂环境交流,并能发出“a”、“i”等元音的A组22例(22/30),B组21例(21/30);仅能发出“ha”、“hi”等音,不能胜任嘈杂环境交流的A组8例(8/30),B组9例(9/30),两组差异无统计学意义(P=0.774)。4周复查误咽发生率:A组为0(0/30),B组为16.7%(5/30),两组差异有统计学意义(P=0.026);术后拔管平均时间A组为(10.0±2.3)d,B组为(20.0±4.6)d,两组差异有统计学意义(P=0.000 0);拔管后再次出现呼吸困难A组为16.7%(5/30),B组为0(0/30),两组差异有统计学意义(P=0.026)。结论:对累及前联合或双侧声带的声门型喉癌,改良喉垂直前位部分切除+双侧胸骨舌骨肌瓣修复术和改良CHEP手术在5年生存率、术后发音效果无统计学差异。前者术后误咽小,拔管时间早,一定程度上减轻了患者的痛苦,但部分患者拔管后因放疗后组织粘连等因素导致呼吸困难需再次住院手术;后者术后误咽相对重,恢复时间长,拔管平均时间相对长,但拔管后不会再次出现呼吸困难,并且手术的适应证更加广泛。两种术式各有优势。
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.
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