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目的分析研究声门下型喉癌的临床特征、外科治疗方法及预后相关因素,探索该型喉癌最合适的外科治疗模式。方法回顾性分析中国医学科学院肿瘤医院头颈外科1987年1月—2001年7月间收治的24例声门下型喉癌患者不同T分期、N分期的3年无瘤生存率,以及不同外科治疗方法及相应的生存率。结果24例声门下型喉癌患者的3年无瘤生存率为50.0%(12/24)。喉全切除术19例患者的3年无瘤生存率为47.4%(9/19),其中T2、T3、T4期的生存率分别为1/1、6/11、2/7;喉部分切除术5例患者的3年无瘤生存率为3/5,T2、T3期的生存率分别为3/4、0/1,其中2例患者病理证实为切缘阳性。本组病例的淋巴结阳性率为33.3%(8/24),T2、T3、T4期的淋巴结阳性率分别为0/5、5/12、3/7。N0、N1、N2期的3年无瘤生存率分别为10/16、1/4、1/4。病理证实阳性淋巴结的部位有Ⅱ区、ⅢⅣ区、气管食管沟、上纵隔、锁骨上窝。结论声门下型喉癌预后差,早期治疗效果好。喉全切除术仍是当前声门下型喉癌主要的外科治疗方式,仅一部分早期高选择患者可行喉部分切除术,并应考虑术后放疗。颈淋巴转移是预后很重要的相关因素。颈淋巴结阳性或者局部病灶晚期的声门下型喉癌患者应行包括Ⅱ～Ⅵ区、上纵隔的淋巴清扫。
Objective To analyze the clinical characteristics, surgical treatment and prognostic factors of subglottic laryngeal cancer and explore the most appropriate surgical treatment model for this type of laryngeal cancer. Methods The 3-year disease-free survival rates of 24 patients with subglottic laryngeal carcinoma treated by Tumor Hospital of Chinese Academy of Medical Sciences from January 1987 to July 2001 were retrospectively analyzed. And the corresponding survival rate. Results The 3-year disease-free survival rate of 24 patients with subglottic laryngeal cancer was 50.0% (12/24). The 3-year disease-free survival rate was 47.4% (9/19) in 19 cases of total laryngectomy, and the survival rates in stage T2, T3 and T4 were 1 / 1,6 / 11 and 2/7 respectively. The 5-year disease-free survival rate was 3/5 in 5 patients, and 3/4 and 0/1 in T2 and T3, respectively. The pathological findings of 2 patients were confirmed as positive margins. The positive rate of lymph nodes in this group was 33.3% (8/24). The positive rates of lymph nodes in stages T2, T3 and T4 were 0/5, 5/12, and 3/7, respectively. The 3-year disease-free survival rates of N0, N1 and N2 were 10/16, 1/4 and 1/4, respectively. Pathologically confirmed lymph node sites Ⅱ, Ⅲ Ⅳ area, tracheoesophageal groove, the mediastinum, supraclavicular fossa. Conclusion The subglottic laryngeal carcinoma has a poor prognosis and early treatment effect. Total laryngectomy is still the main surgical treatment of subglottic laryngeal carcinoma, only part of the early high-selection patients underwent partial laryngectomy, and postoperative radiotherapy should be considered. Cervical lymph node metastasis is a very important prognostic factor. Patients with cervical lymph node-positive or advanced subglottic laryngeal cancer should include lymph node dissection in grade Ⅱ-Ⅵ and upper mediastinum.