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目的 :探讨T1、T2 期声门型喉癌的治疗方法。方法 :对 112例T1、T2 期声门型喉癌 (T1N0 M0 、T2 N0 M0 )患者施行喉小部分切除术。对手术方法、术后功能的恢复、治疗效果及治疗优势进行了总结 ,并与激光、放疗作了对比 ;对术后披裂的活动、声门裂的形态及嗓音变化作了动态观察随访 ;应用Dr.speech嗓音质量评估软件对术前、术后嗓音质量做了分析对比。结果 :112例患者切口均Ⅰ期愈合 ,6～ 7d拆线 ,平均住院时间 9.76d。术后 2～ 3d恢复经口进食。住院期间顺利拔除气管套管 ,平均戴管时间 7.32d,拔管率 10 0 %。术后 1周 4 7例出现披裂活动减弱 ,但逐步改善 ,2个月后声门裂形态接近正常 ;术前与术后 2个月、6个月Shimmer和NNE对比 ,差异有统计学意义 (P <0 .0 1) ,术后 1周与术后 2个月、6个月比较差异有统计学意义 (P <0 .0 1)。随访满 3年76例 ,全部生存 ;满 5年 36例 ,35例生存 (1例不明原因死亡 ) ;复发 2例。结论 :喉小部分切除术视野清楚 ,病变切除彻底 ,短期内顺利恢复了饮食及语言功能 ,并提高了发声质量 ,治疗T1、T2 期声门型喉癌是可行的。
Objective: To investigate the treatment of glottic laryngeal cancer in stages T1 and T2. Methods: A total of 112 patients with T1 and T2 glottic laryngeal carcinoma (T1N0 M0, T2 N0 M0) underwent partial laryngectomy. The surgical methods, postoperative functional recovery, therapeutic effects and treatment advantages were summarized and compared with laser and radiotherapy; follow-up was made on the activity of peristalsis, the morphology of the glottic fissure and voice changes; Dr.speech voice quality assessment software for preoperative and postoperative voice quality analysis and comparison. Results: The wounds of 112 patients were all healed by first intention. The stitches were removed 6-7 days and the average hospital stay was 9.76 days. 2 ~ 3d after surgery to restore oral intake. Successful removal of tracheal tube during hospitalization, the average wearing time 7.32d, extubation rate of 10%. The fissure activity was weakened in 47 cases 1 week after operation, but gradually improved. The morphology of gliomas was nearly normal after 2 months. There was significant difference in Shimmer and NNE between preoperative and postoperative 2 months and 6 months P <0.01). There was a significant difference between one week after surgery and two months after surgery and six months after surgery (P <0.01). All cases were followed up for 3 years and 76 cases survived completely; 35 cases survived in 5 years (1 case died of unknown cause) and 2 cases relapsed. Conclusion: The small partial laryngectomy has a clear field of vision, thorough removal of the lesion, the successful restoration of diet and language function in the short term and the improvement of sound quality. It is feasible to treat T1 and T2 glottic laryngeal cancer.