【摘要】 目的探讨单侧中位喉切除术应用于T2~3期声门型喉癌的临床优势。方法选择病灶局限于单侧的25例T2~3期声门型喉癌患者为中位喉组,予患侧中位喉切除术,颈淋巴结转移者行择区性淋巴结清扫术,统计误咽、发音、拔管及生存率,并以同期行垂直半喉切除术的22例单侧T2~3声门癌患者作为对照组进行对比。结果术后中位喉组误咽率12%(3/25),对照组误咽率18%(4/22)。2组均无患者并发咽瘘。中位喉组3例声门或声门上水平狭窄,1例术后3个月呼吸困难,均予气管切开终身带管,拔管率为84%(21/25)。对照组7例拔管困难,拔管率68%(15/22)。2组患者的误咽率及拔管率比较差异均无统计学意义(P均>0.05)。与术前相比,2组患者术后6个月的基频微扰、标准化噪声能量均增高(P均<0.01),手术前后振幅微扰比较差异无统计学意义(P>0.05);2组上述指标在组间比较差异均无统计学意义(P均>0.05)。中位喉组和对照组患者术后3、5年累积生存率分别为86%、77%和80%、68%,2组生存曲线比较差异有统计学意义(P﹤0.05)。结论单侧中位喉切除术作为垂直半喉切除术的改良术式,较完整地保留了喉腔的形态及其生理功能,其生存率优于垂直半喉切除术患者。更多还原

【Abstract】 Objective To evaluate the clinical value of middle laryngectomy in the treatment of stage T2-3 glottic laryngeal carcinoma. Methods Twenty five patients with unilateral stage T2-3 glottic laryngeal carcinoma underwent middlelaryngectomy. Those with lymph node metastasis received elective lymph node dissection. The incidence of deglutition disorder,pronunciation,extubation and survival rate were recorded.Twenty two patients with unilateral stage T2-3 glottic laryngeal carcinoma undergoing vertical laryngectomy were recruited as controls. Results At postoperative,3 cases( 12%) in the middle laryngectomy group developed deglutition disorder,and 4 patients( 18%) in the control group presented with deglutition disorder. None of the patients in two groups had pharyngeal fistula. The extubation rate was calculated as 84%( 21 /25) in the middle laryngectomy group,and 68%( 15 /22) in the control group. The jitter and normalized noise energy were significantly enhanced at postoperative 6 months compared with preoperative values( both P < 0. 01). The rates of deglutition disorder and extubation in two groups did not significantly differ between two groups( all P> 0. 05). The shimmer did not significantly differ before and after surgery( P > 0. 05). The jitter,shimmer and normalized noise energy did not significantly differ between two groups( all P > 0. 05). The 3- and 5-year cumulative survival rate was 86% and 77% in the middle laryngectomy group,and 80% and 68% in the control group. Conclusions Unilateral middle laryngectomy is an improved surgery based on vertical laryngectomy. It can reserve the laryngeal morphology and retain physiological function. It yields higher survival rate compared with vertical laryngectomy.更多还原