庄惠学 纪宏志 梁树新 贡振杨 林家峰 朱萍 250031 济南军区总医院耳鼻咽喉科 中华耳鼻咽喉科杂志 1999 0 34 6


    关键词：喉肿瘤；；喉切除术；存活率；声门 期刊 zhebyhzz 0 喉癌喉功能保留手术 fur -->


    

【摘要】 目的 探讨声门下癌的临床特点、手术和重建喉功能的方法及喉声门下部分切除术的可行性。方法 总结1981～1997年声门下癌13例，T_1-2 N₀ 6例,T₃ N₀ 1例,T_3-4 N_1-2 6例。4例行全喉切除术，9例行喉声门下部分切除术和扩大喉声门下部分切除术(累及气管者)，分别以单侧或双侧皮瓣、肌筋膜瓣整复，喉腔内置“T”型硅胶管扩张，2～6个月拔除。其中6例行颈清扫术。结果 除4例全喉切除术者外，余9例均恢复发音功能。5例拔除气管套管，占55.6%，全部恢复吞咽功能。全喉切除和喉声门下部分切除术的3、5年存活率分别为100%、66.7%和88.9%、75.0%。结论 对40岁以上的男性声嘶患者应常规行纤维喉镜和动态喉镜检查，结合CT、MRI等，早期诊断是可能的。对大部分患者仍可行喉声门下部分切除术或扩大切除术。并提出对T₃ 、T₄ 者应酌情行颈清扫术。术后预防性放射治疗是必要的。

Surgical management ofsubglottic carcinoma

ZHUANG Huixue,JI Hongzhi, LIANG Shuxin, etal.Department of Otorhinolaryngoloy,Jinan Military General Hospital,Jinan 250031

【Abstract】 Objective Toexplore the clinical features and the methods of surgery and functional restoration ofsubglottic carcinoma. Methods Thirteen cases with primary subglotticcarcinoma were treated surgically in this department from 1981 to 1997. Among them, sixhad T_1-2 N₀ lesions, one had T₃ N₀ lesion andsix had T_3-4 N_1-2 lesions. Four cases underwent total laryngectomy andnine had subglottic partial laryngectomy. The extensive subglottic partial laryngectomywas performed on patients with tracheal invasion. The defects of larynx were reconstructedby using unilateral or bilateral pedicled musculocutaneous flap, myofascial flapaccordingly. T-shape silastic tube was placed in to the reconstructed cavity of larynxduring the operation and the patients were decannulated in 2 to 6 months. Unilateralradical neck dissection was performed on 4 patients and bilateral on 2. Results All cases had restored the function of phonation except for 4 who underwent total laryngectomy. Five out of 9 (55.6%) were decannulated. The swallowing function wasrestored in all patients. The 3-year and 5-year survival rates were 100% and 66.7% in thecases with total laryngectomy, 88.9% and 75.0% with subglottic partial laryngectomy,respectively. Conclusion It is possible to detect early subglotticcarcinoma by using fiberoptic laryngoscopy routinely with the combination of stroboscopy,CT, MRI in male patients over 40 with hoarseness. It is practical that the whole orpartial function of larynx could be restored in most cases with subglottic carcinoma afterpartial laryngectomy or subtotal laryngectomy. Unilateral or bilateral neck dissectionshould be performed on patients with T₃ or T₄ lesion. Postoperativeradiotherapy is necessary.

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