摘要： 目的 探讨保留杓状软骨在喉次全切除环舌根会厌吻合术中的应用及疗效。方法 回顾性收集我院1998年1月至2013年12月216例声门型喉癌行喉次全切除环舌根会厌吻合术患者的临床资料。按照是否保留杓状软骨分为未保留杓状软骨组和保留杓状软骨组。采用Kaplan-Meier法行生存率统计,采用log-rank检验行生存率差异比较。结果 216例患者的随访率为91.5%,3年总生存率为84.9%,5年总生存率为72.3%,未保留杓状软骨组的3年和5年生存率分别为82.5%和70.3%,保留杓状软骨组的3年和5年生存率分别为85.8%和75.3%。所有患者术后发音均恢复。拔管率为94.5%。误咽率为8.3%。结论 喉次全切除环舌根会厌吻合术是保留喉发音、呼吸和吞咽功能的有效手术方法,最常见的并发症是误咽。保留单侧或双侧杓状软骨不仅可有效降低误咽率,还可提高患者术后的生存率,因此该手术方法值得推广。

保留杓状软骨在喉次全切除环舌根会厌吻合术中的应用

杜晶静, 惠莲, 郭星

中国医科大学附属第一医院耳鼻咽喉科, 沈阳 110001

收稿日期:2019-12-04出版日期:2020-06-30发布日期:2020-06-15
通讯作者:惠莲E-mail:huilian613@126.com
作者简介:杜晶静(1984-),女,医师,硕士.
基金资助:辽宁省自然科学基金（20170541050）


关键词: 喉癌, 外科治疗, 保留喉功能, 生存率
Abstract: Objective To examine the applications and curative effects of retaining arytenoid cartilage during subtotal laryngectomy with ring-tongue-root and epiglottic anastomosis. Methods The clinical data of 216 cases of glottic carcinoma treated with subtotal laryngectomy and anastomosis of ring root and epiglottis,from January 1998 to December 2013,were collected retrospectively. The cases were divided into two groups according to whether the arytenoid cartilage was preserved or not. Subsequently,the survival rate was calculated using the Kaplan-Meier method and the difference in survival rate was tested using the log-rank test. Results The follow-up rate was 91.5%. Regarding survival rate,the overall 3-year and 5-year survival rates were 84.9% and 72.3%,respectively;the 3-year and 5-year survival rates in the non-preserved arytenoid cartilage group were 82.5% and 70.3%,respectively;and the 3-year and 5-year survival rates in the retained arytenoid cartilage group were 85.8% and 75.3%,respectively. All patients recovered their phonation function after surgery. The rates of extubation and swallowing error were 94.5% and 8.3%,respectively. Conclusion Subtotal laryngectomy and anastomosis of ring root and epiglottis is an effective surgical method to preserve laryngeal phonation,aspiration,and swallowing function. The most common complication of this treatment is swallowing error. Reserving one or both sides of the arytenoid cartilage can not only reduce swallowing error but also improve the survival rate of patients.
Key words: laryngeal neoplasms, surgical treatment, larynx preservation, survival rate
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