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目的 :评价各种喉部分切除术的远期疗效。方法 :对 1984年 3月至 1998年 3月的 2 6 4例喉癌患者行喉部分切除术。手术方法共 8种 :激光声带切除术 19例 ,喉裂开声带切除术 2 9例 ,侧位垂直喉部分切除术 5 8例 ,前位喉部分切除术 18例 ,声门上水平喉部分切除术 4 2例 ,水平垂直喉部分切除术 2 9例 ,扩大喉次全切除术5 1例 (其中扩大至舌根 2 3例 ,扩大至梨状窝 2 5例 ,扩大至气管 3例 ) ,近全喉切除术 18例。同期行颈廓清术 113例 (14 6侧 ,其中功能性 98侧 ,根治性 4 8侧 )。修补材料有颈部皮肌瓣、颈前肌筋膜瓣、室带下移成形声带、局部喉粘膜、甲状软骨膜、会厌下移等 ,酌情单独应用或联合应用。结果 :所有患者均能讲话 ,进行语言交流。 89例无误咽 ,112例轻度误咽 ,5 7例中度误咽 ,6例重度误咽。拔管率 82 .95 %。 3、5、10年生存率分别为 86 .74 %、78.4 7%、5 3.33%。死亡的主要原因是局部复发和颈淋巴结转移 ,死亡 (包括失访 )的患者中 71.4 %死于 3年内。结论 :喉部分切除术和全喉切除术都是喉癌的根治性手术 ;正确掌握手术适应证是手术成败的关键 ;提高拔管率是提高患者生存质量的重要标志 ;合理地处理颈部淋巴结是提高 3、5年生存率的重要环节。
Objective: To evaluate the long-term efficacy of various laryngectomies. Methods: Twenty-four patients with laryngeal cancer underwent partial laryngectomy from March 1984 to March 1998. There were 8 surgical methods: laser vocal cordctomy in 19 cases, laryngeal rupture open vocal cord resection in 29 cases, lateral vertical laryngectomy in 58 cases, anterior partial laryngectomy in 18 cases, supraglottic partial laryngectomy 42 cases of horizontal surgery, 29 cases of vertical horizontal partial laryngectomy, 51 cases of laryngectomy (enlarged to 23 cases of tongue base, 25 cases of pyriform sinus expanded to 3 cases of trachea) Total laryngectomy in 18 cases. During the same period, 113 cases of neck dissection (14 6 sides, of which 98 were functional and 48 were radical) were performed. Repair materials are neck skin flap, anterior cervical myofascial flap, chamber with the formation of vocal cord down, local laryngeal mucosa, thyroid perichondrium, epiglottis shift down, as appropriate, alone or in combination. Results: All patients were able to speak and communicate verbally. 89 cases of no swallowing, 112 cases of mild swallow, 57 cases of moderate swallow, 6 cases of severe swallow. Extubation rate of 82.95%. The 3, 5 and 10-year survival rates were 86.74%, 78.47% and 5 3.33% respectively. The main cause of death was local death and cervical lymph node metastasis, death (including lost) 71.4% of patients died within 3 years. Conclusions: Partial laryngectomy and total laryngectomy are both radical surgery for laryngeal cancer. It is the key to the success or failure of laryngeal cancer that the operation indications are correctly grasped. Increasing the rate of extubation is an important symbol to improve the quality of life of patients. Reasonable treatment of cervical lymph nodes Is to improve the survival rate of 3-5 years an important part.