扩大垂直半喉切除术和环状软骨舌骨会厌吻合术疗效观察和术后评估

doi:10.3760/cma.j.issn.1673-0860.2010.04.010

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题名	扩大垂直半喉切除术和环状软骨舌骨会厌吻合术疗效观察和术后评估
其他题名	Comparing extended vertical partial laryngectomy and cricohyoidoepiglottopexy in the treatment of laryngeal carcinoma
作者	林刃舆; 陈建福; 郭志强; 彭建华; 周健; 方渭清
发表日期	2010-04-07
发表期刊	中华耳鼻咽喉头颈外科杂志影响因子和分区
语种	中文
原始文献类型	学术期刊
关键词	喉肿瘤喉切除术存活率预后
其他关键词	Laryngeal neoplasms ; Laryngectomy ; Survival rate ; Prognosis
摘要	目的扩大垂直半喉切除和传统喉环状软骨上部分切除环舌骨会厌吻合术(cricochyoidoepiglottopexy,CHEP)的疗效和术后评估的比较。方法回顾性分析1998—2005年扩大垂直半喉切除患者和传统喉环状软骨上部分切除环舌骨会厌吻合术式患者临床资料。扩大垂直半喉切除方法为:按类似扩大垂直半喉术式的方法切除健侧声带、室带及1/3至2/3左右的甲状软骨板,保留健侧环杓关节,切除患侧声带、室带、患侧活动受限或固定的杓状软骨及患侧2/3左右甲状软骨板,保留双侧甲状软骨板的后缘,直接将环状软骨上提和舌骨会厌固定吻合。扩大垂直半喉切除组(简称改良组):37例声门型喉癌,T2 16例,T3 21例。传统CHEP组:34例声门型喉癌,T2 12例,T321例,T4 1例。结果 Kaplan-Meier法统计生存率,改良组的3年累积生存率为91.7%,传统CHEP组为87.5%,差异无统计学意义(P>0.05)。改良组的5年累积生存率为80.6%,传统CHEP组为81.3%,差异无统计学意义(P>0.05)。术后拔管率改良组为100.0%(37/37),传统CHEP组为94.1%(32/34),两组差异无统计学意义(P>0.05)。术后拔管平均时间((?)±s)改良组为(14.0±2.3)d,传统CHEP组为(19.0±4.6)d,两组差异有统计学意义(t=5.80,P<0.001)。术后8周评价误咽发生率,改良组为2.7%(1/37),传统CHEP组为23.5%(8/34),两组差异有统计学意义(P<0.05);术后误咽呛咳评分通过Ridit分析,结果表明两组之间差异有统计学意义(U=7.341,P<0.001),改良组误咽呛咳的不适症状明显轻于传统CHEP组。结论扩大垂直半喉切除在肿瘤根治上和传统CHEP术式无差别,而在喉功能保全上优于传统CHEP术式。
其他摘要	Objective To compare the results of extended vertical partial laryngectomy (similar to modified supraericoid partial laryngectomy with cricohyoidoepiglottopexy) and cricohyoidoepiglottopexy in the treatment of laryngeal carcinoma.Methods Retrospectively analyzed on the results and prognosis in pafients underwent extended vertical partial laryngectomy and cricohyoidoepiglottopexy between 1998 and 2005.The operation was similar to extended vertical partial laryngectom.The healthy vocal cord and ventricular band as well as about 1/3 to 2/3 laminas of thyoid cartilage were removed.The healthy cricoarytenoid joint was reserved.The vocal cord,ventricular band,fixed or limitation of motion arytenoid cartilage and 2/3 laminas of thyoid cartilage in ill side were removed.The posteroinferior border of laminas of thyoid cartilage in both sides were reserved.The cricoid was lifted and fixed with hyoid epiglottis directly.Extended vertical partial laryngeetomy group consisted of 37 patients with glottic carcinoma (stage T2 16 cases,stage T3 21 cases) and cricohyoidoepiglottopexy group consisted of 34 patients with glottic carcinoma (stage T2 12 cases,stage T3 21 cases,stage T4 l case) .Results Kaplan-Meier analysis was performed to calculate the survival rates.The three-year cumulative survival rate was 91.7%in extended vertical partial laryngectomy group and 87.5%in cricohyoidoepiglottopexy group respectively.There was no significant difference between the two groups (P>0.05) .The five-year cumulative survival rate was 80.6%in extended vertical partial laryngectomy group and 81.3%in cricohyoidoepiglottopexy group respectively.There was also no significant difference between the two groups (P>0.05) .The decannulation rate was 100% (37/37) in extended vertical partial laryngectomy group and 94.1% (32/34) in cricohyoidoepiglottopexy group respectively.The decannulation time was (14.0±2.3) days in extended vertical partial laryngectomy group and (19.0±4.6) days in cricohyoidoepiglottopoxy group respectively.The incidence of aspiration was 2.7% (1/37) in modified group and 23.5 (8/34) in cricohyoidoepiglottopexy group respectively evaluated at 8th weeks post-operatively.The evaluation of deglutition disorder was analyzed by Ridit analysis in both groups and the results showed that there was significant difference between the two groups (U=7.341,P<0.001) .The symptom of aspiration in extended vertical partial laryngectomy group was significant less than in cricohyoidoepiglottopexy group.Conclusions Although the survival rate was not different between the two groups.The preservation of laryngeal function in extended vertical partial laryngectomy group was significant better than in cricohyoidoepiglottopexy group and extended vertical partial laryngectomy.
ISSN	1673-0860
卷号	45 期号:04 页码:305-309
DOI	10.3760/cma.j.issn.1673-0860.2010.04.010
页数	0
收录类别	CNKI ; 万方 ; 北大核心 ; PKU ; CSCD ; ISTIC
学科领域	医药、卫生 ; 耳鼻咽喉科学
URL	查看原文
CSCD记录号	CSCD:3861712
万方分类号	R76(耳鼻咽喉科学)
引用统计
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/71961
专题	附属第一医院_耳鼻咽喉科
作者单位	温州医学院附属第一医院耳鼻咽喉科
第一作者单位	附属第一医院_耳鼻咽喉科
第一作者的第一单位	附属第一医院_耳鼻咽喉科
推荐引用方式 GB/T 7714	林刃舆,陈建福,郭志强,等. 扩大垂直半喉切除术和环状软骨舌骨会厌吻合术疗效观察和术后评估[J]. 中华耳鼻咽喉头颈外科杂志,2010,45(04):305-309.
APA	林刃舆, 陈建福, 郭志强, 彭建华, 周健, & 方渭清. (2010). 扩大垂直半喉切除术和环状软骨舌骨会厌吻合术疗效观察和术后评估. 中华耳鼻咽喉头颈外科杂志, 45(04), 305-309.
MLA	林刃舆,et al."扩大垂直半喉切除术和环状软骨舌骨会厌吻合术疗效观察和术后评估".中华耳鼻咽喉头颈外科杂志 45.04(2010):305-309.