喉近全切除术在中晚期喉癌患者中的应用
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摘要
目的探讨喉近全切除术在中晚期喉癌患者中的应用效果。方法回顾110例确诊喉癌并实施近全喉切除术患者的病例资料,其中喉垂直切除会厌下移术式(Tucker术式)84例,环舌骨会厌固定术式(CHEP术式)26例。结果 Tucker组和CHEP组患者均取得了良好的术后生存率; 2组患者术后1个月评估均能发音,大部分音质粗哑,但不影响日常语言交流;大部分患者术后存在不同程度的误咽,其中Tucker组35例,CHEP组12例;经一段时间训练与适应后,所有患者顺利克服误咽,恢复正常进食;拔管情况:全部患者7～15 d后可全堵管;并发症:Tucker组有3例患者术后因创面肉芽形成致喉狭窄,2例术后复发再次行全喉切除术,CHEP组有2例肺内感染,1例气管切开口周围皮肤感染,经积极抗感染治疗及加强局部换药而治愈,2例患者术后出现喉狭窄。结论 Tucker术式及CHEP术式这两种喉近全切除术既可提升中晚期喉癌患者的生存率,又可在呼吸、吞咽以及言语功能恢复方面取得满意效果。
Objective To evaluate the application of proximal total laryngectomy in patients with laryngeal carcinoma in middle and terminal stages. Methods The data of 110 patients confirmed as laryngeal carcinoma and undergoing proximal total laryngectomy was retrospective analyzed,including 84 cases with Tucker surgery and 26 cases with fixation of cricohyoid epiglottis(CHEP).Results Both the Tucker group and the CHEP group had better postoperative survival rate. All patients were able to pronounce after one month of surgery. Although the voice was hoarse,their daily communication did not be affected. Erroneous deglutition after surgery occurred in most patients,with35 case in Tucker group and 12 case in CHEP group,and all patients could conquer erroneous deglutition,and recovered to normal eating after a course of training. All patients had tube-blocking at 7 to15 d after surgery. The laryngeal stenosis caused by wound granulation was formed in three patients in Tucker group,and two patients had cancer recurrence. In CHEP group,two patients had pulmonary infection,one had the skin infection,two with laryngeal stenosis. Conclusion Tucker and CHEP can improve survival rate of patients with intermediate and terminal laryngeal carcinoma,and have satisfactory results in the recovery of breathing,swallowing and pronunciation.
Objective To evaluate the application of proximal total laryngectomy in patients with laryngeal carcinoma in middle and terminal stages. Methods The data of 110 patients confirmed as laryngeal carcinoma and undergoing proximal total laryngectomy was retrospective analyzed,including 84 cases with Tucker surgery and 26 cases with fixation of cricohyoid epiglottis(CHEP).Results Both the Tucker group and the CHEP group had better postoperative survival rate. All patients were able to pronounce after one month of surgery. Although the voice was hoarse,their daily communication did not be affected. Erroneous deglutition after surgery occurred in most patients,with35 case in Tucker group and 12 case in CHEP group,and all patients could conquer erroneous deglutition,and recovered to normal eating after a course of training. All patients had tube-blocking at 7 to15 d after surgery. The laryngeal stenosis caused by wound granulation was formed in three patients in Tucker group,and two patients had cancer recurrence. In CHEP group,two patients had pulmonary infection,one had the skin infection,two with laryngeal stenosis. Conclusion Tucker and CHEP can improve survival rate of patients with intermediate and terminal laryngeal carcinoma,and have satisfactory results in the recovery of breathing,swallowing and pronunciation.
引文
[1]刘文胜,李正江,张国芬,等. T3期声门上喉癌的临床治疗探讨[J].中华肿瘤杂志,2017,39(8):613-617.
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[7]王霞,许尧生.喉次全切除术后误咽情况的临床观察[J].中国耳鼻咽喉颅底外科杂志,2016,22(1):72-74.
[8] Mannelli G,Meccariello G,Deganello A,et al. Subtotal supracricoid laryngectomy:changing in indications, surgical techniques and use of new surgical devices[J]. Am J Otolaryngol,2014,35(6):719-726.
[9] Hafiz G,Baaran B,Ulusan M,et al. A new extended supracricoid laryngectomy technique for tongue base and hyoid bone involvement:crico-glosso-mandibulopexy technique[J].Kulak Burun Bogaz Ihtis Derg,2014,24(3):181-184.
[10] Dhaha M,Jbali S,Dhambri S,et al. Laryngocele after subtotal laryngectomy[J]. Iran J Otorhinolaryngol,2018,30(100):305-308.
[11] Buzaneli E C P,Zenari M S,Kulcsar M A V,et al. Supracricoid laryngectomy:the function of the remaining arytenoid in voice and swallowing[J]. Int Arch Otorhinolaryngol,2018,22(3):303-312.
[12] Somuk B T,Ciftci O,Aygenc E. Evaluation of cases who underwent reconstruction through pectoralis major myocutaneous flap after laryngopharyngectomy[J]. Turk Arch Otorhinolaryngol,2016,54(2):58-62.
[13]熊国平,刘芳,严飞鹏,等.改良环状软骨上喉次全切除术疗效分析[J].中国耳鼻咽喉颅底外科杂志,2018,24(5):472-475.
[14]夏少玲,黄顺德.早期功能训练对环状软骨上喉部分切除术后喉癌患者吞咽功能的影响[J].广州医药,2018,49(4):61-63.
[15]王茹,房居高,马泓智,等.改良环状软骨上喉部分切除术治疗中晚期喉癌的疗效及生存质量评估[J].中国耳鼻咽喉头颈外科,2017,24(11):557-560.
[2] Kurosawa K,Imai T,Matsumoto K,et al. A novel laryngeal preservation technique following total glossectomy with hyoid bone resection[J]. Plast Reconstr Surg Glob Open,2018,6(4):e1756.
[3]马士崟,王晓敏,韩跃峰,等. 381例喉癌保留喉功能的手术治疗[J].中国中西医结合耳鼻咽喉科杂志,2016,24(5):347-352.
[4] Zhang C Y,Zhu M H,Chen D H,et al. Organ preservation surgery for patients with T4a laryngeal cancer[J]. Eur Arch Otorhinolaryngol,2018,275(6):1601-1606.
[5]林刃舆,陈建福,郭志强,等.不同手术方案的喉癌患者喉环状软骨上部分切除术后发生误咽的比较[J].中华肿瘤杂志,2011,33(1):63-66.
[6]熊国平,刘芳,严飞鹏,等.改良环状软骨上喉次全切除术疗效分析[J].中国耳鼻咽喉颅底外科杂志,2018,24(5):472-475.
[7]王霞,许尧生.喉次全切除术后误咽情况的临床观察[J].中国耳鼻咽喉颅底外科杂志,2016,22(1):72-74.
[8] Mannelli G,Meccariello G,Deganello A,et al. Subtotal supracricoid laryngectomy:changing in indications, surgical techniques and use of new surgical devices[J]. Am J Otolaryngol,2014,35(6):719-726.
[9] Hafiz G,Baaran B,Ulusan M,et al. A new extended supracricoid laryngectomy technique for tongue base and hyoid bone involvement:crico-glosso-mandibulopexy technique[J].Kulak Burun Bogaz Ihtis Derg,2014,24(3):181-184.
[10] Dhaha M,Jbali S,Dhambri S,et al. Laryngocele after subtotal laryngectomy[J]. Iran J Otorhinolaryngol,2018,30(100):305-308.
[11] Buzaneli E C P,Zenari M S,Kulcsar M A V,et al. Supracricoid laryngectomy:the function of the remaining arytenoid in voice and swallowing[J]. Int Arch Otorhinolaryngol,2018,22(3):303-312.
[12] Somuk B T,Ciftci O,Aygenc E. Evaluation of cases who underwent reconstruction through pectoralis major myocutaneous flap after laryngopharyngectomy[J]. Turk Arch Otorhinolaryngol,2016,54(2):58-62.
[13]熊国平,刘芳,严飞鹏,等.改良环状软骨上喉次全切除术疗效分析[J].中国耳鼻咽喉颅底外科杂志,2018,24(5):472-475.
[14]夏少玲,黄顺德.早期功能训练对环状软骨上喉部分切除术后喉癌患者吞咽功能的影响[J].广州医药,2018,49(4):61-63.
[15]王茹,房居高,马泓智,等.改良环状软骨上喉部分切除术治疗中晚期喉癌的疗效及生存质量评估[J].中国耳鼻咽喉头颈外科,2017,24(11):557-560.