喉全切除术后二期气管食管裂隙状瘘发音重建术效果观察

目的恢复喉全切除术后患者发音功能。方法对224例喉全切除患者行二期气管食管裂隙状瘘发音重建术,对合并颈前瘢痕而影响下咽食管上段气流顺利通过者行颈前瘢痕松解,术后随访观察发音及吞咽情况。结果 224例患者术后均能发音,其中发音优良者占96.4%（216/224）。105例患者存有不同程度的误咽,30例中重度误咽患者中12例利用颞肌筋膜封闭气管食管瘘孔,4例利用颞肌筋膜或局部缝合缩小气管食管瘘孔,2例放置发音钮。结论二期气管食管裂隙状瘘发音重建术是喉全切除后患者恢复言语功能的有效术式,操作简便,术后即可发音。对影响下咽及食管上段气流顺利通过的颈前瘢痕同期予以松解,可有效提高发音成功率。术后误咽是最常见的并发症,经简单干预多可基本控制,必要时可手术治疗。     

双蒂喉外肌瓣加颈前肌皮瓣在喉功能重建术中的应用

双蒂喉外肌瓣加颈前肌皮瓣在喉功能重建术中的应用诸城市人民医院（２６２２００）陈会昌顾志信刘彦军逄建云秦术国自１９８３年开始，我们采用双蒂喉外肌瓣加颈前肌皮瓣对１０例喉癌切除患者行一期喉功能重建术，取得了良好效果。临床资料：本组均为男性，年龄３８～６７...     

喉癌切除颈阔肌肌筋膜瓣整复术25例

对２５例喉癌患者施行切除术以颈阔肌肌筋膜瓣进行整复，全部或部分恢复了喉的三大功能。介绍了手术方法、肌筋膜瓣的制作，以及此种喉功能重建术与其它方法的比较，并进行了讨论。     

70岁及以上喉癌患者的喉功能保全手术治疗

目的 分析70岁以上老年喉癌患者行喉功能保全手术的方法及疗效. 方法 136例原发喉癌患者,行声带切除34例,垂直半喉切除28例,喉声门上水平部分切除24例,喉3/4切除15例,次全喉切除29例,全喉切除环咽吻合术6例.T3-4期病灶切除后多采用颈部肌皮瓣修复.术后可在气管套管外放置麻醉气囊,练习进食. 结果 全部患者术后1周均恢复发音功能,92例拔除气管套管.45例有不同程度呛咳,经过吞咽练习后好转,1例失败.围手术期无死亡.3年和5年生存率分别为78.7%和68.5%. 结论 对70岁以上老年喉癌患者,术前评估准确、术式选择和围手术期处理得当,可行喉功能保全.     

喉次全切除术在晚期喉癌中的应用与评价

临床上治疗晚期喉癌往往实行全喉切除术,使患者失去发音功能.Pearson报告对T3喉癌患者施行近全喉切除术,既切除肿瘤又保留患者的发音功能,效果满意[1].现结合我院对23例T3喉癌患者施用Pearson手术的经验做以下评价.     

喉癌患者胸舌肌瓣喉重建术后喉功能的恢复（附66例分析）

对接受胸舌肌瓣理建术的６６例喉癌者术后的呼吸、发音及协调吞咽功能情况进行了随访分析。结果显示，７７％的患者术后能拔除气管套管，恢复正常呼吸；近９０％的患者能正常语言效流；患者均逐步恢复正常进食。揭示该术式可使大部喉癌患者获得根治与喉功能并存的良好效果，随着该术式的不断完善，可进一步改善患者术后的喉功能。     

老年人喉癌喉切除术的疗效分析

目的探讨老年喉癌患者行喉切除术的疗效和可行性。方法回顾性研究上海交通大学医学院附属第九人民医院奉城分院耳鼻咽喉科和上海交通大学医学院附属第九人民医院耳鼻咽喉科自1996年至2009年的122例60岁及以上的接受各种喉切除手术的老年人喉癌患者,其中男117例,女5例;年龄60～94岁,中位年龄68岁;95例（77．9％）患者有全身合并症。按2002年国际抗癌联盟（international union against cancer,UICC）标准,I期16例,Ⅱ期24例,Ⅲ期52例和Ⅳ期30例。在彻底切除病变的基础上,尽量保留喉的正常组织和喉的功能,切除时保留安全缘≥5mm。采用三种手术方式：经口支撑喉镜显微镜下激光喉癌切除术（10例）、喉部分切除术（25例）和全喉切除术（87例）,同时参照2004年大连会议标准行颈淋巴结清扫术。结果122例患者术后伤口I级愈合114例（占93．4％）;Ⅱ级愈合5例;Ⅲ级愈合3例,其中2例发生咽瘘,经积极换药的处理和营养对症支持治疗,2w后创面愈合。所有患者进食均无困难,围手术期均无合并症的加重与恶化。本组1、3、5年随访率分别为100％（122／122）、97．2％（106／109）、92．9％（91／98）,采用直接法统计生存率,失访按死亡计算;1、3、5年生存率97．5％（119／122）、84．4％（92／109）、68．4％（67／98）。结论老龄不是喉癌患者行喉切除术的禁忌证,在有充分的术前准备、严格掌握适应证和积极的围手术期处理的前提下,手术仍是治疗老年喉癌患者的主要手段。     

喉癌手术15例疗效分析

目的观察喉癌手术的临床疗效。方法分析我收治喉癌15例,病理诊断为鳞状细胞癌。按1997年UICC的TNN分期,T1NOMO2例,T2NONO8例,T2N1MO2例,T3N1NO1例,T3N2MO2例。全部常规气管切开,其中喉裂开声带切除术2例,喉垂直部分切除8例,喉声门上水平部分切除3例,喉全切除2例。同时行同侧颈廓清术4例,双侧颈廓清术1例。对保留喉功能的13例,术后7—14d开始堵管1d后,上下3楼无气促者,拔除气管套管。Ⅲ期以上者术后补充放疗（60～70Gy）。结果术后随访3年以上,死亡3例,1例死于脑血管意外,2例死于肺转移及肝转移,无瘤存活12例。3年生存率86．66％（12／15）,5年生存率80％（2／10）。除2例全喉切除的13例,术后全部拔管,拔管率86．6％;所有保留喉功能患者,生活质量较好。结论提高生存率的关键是早期发现和综合治疗。只要合理地掌握手术适应证,喉部分切除术与喉全切除术治疗喉癌的不会降低生存率,而且可以明显提高生活质量。     

135例喉癌行喉部分切除术后的疗效分析

对资料完整的１３５例喉部分切除术后的喉癌患者进行了疗效分析，统计了各期喉癌的术后３年、５年生存率，并对术后喉功能的恢复情况进行了讨论，提出喉癌行喉部分切除术后的疗效分析应包括术后生存率和喉功能恢复两个方面。     

喉全切除+气管咽吻合、喉功能重建术16例报告

1993-2004年，我们对16例喉癌患者行喉全切除 气管咽吻合、喉功能重建术，术后呼吸、吞咽、语言功能均恢复，效果满意。现报告如下。     

70岁及以上老年人喉癌发病特点及预后——155例病例回顾

目的对70岁及以上喉癌患者的发病特点及预后进行探讨。方法对2006年10月至2008年10月复旦大学附属眼耳鼻喉科医院收治的70岁及以上喉癌病例共155例,进行回顾和随访。总结其发病特点,治疗方式和预后。结果全组患者共155人,平均年龄（75．7±4．8）岁,男女比例24．8：1。发病时间〈1月-600个月,中位时间4个月。声门型116人,声门上型31人,跨声门型8人。临床分期：1、2期98人,3、4期56人。术前合并症：高血压50人（32．3％）,心律失常11人（7．1％）,冠心病5人（3．2％）,慢性阻塞性肺疾病6人（3．9％）,陈旧性肺结核、支扩、哮喘、肺癌术后等其他呼吸系统疾病4人（2．6％）,糖尿病11人（7．1％）,贫血1人（0．6％）。治疗方式：根治性放疗13例（8．4％）,显微喉镜下激光喉癌切除术14例（11．5％）,部分喉切除术40例（32．8％）,全喉切除术5l例（54．1％）,全喉或部分喉切除术＋颈淋巴结清扫17例（13．9％）,姑息手术或未治20例（12．9％）,和全年龄组比较差异有统计学意义（P〈0．05）。随年龄增长,患者接受姑息治疗和主动放弃治疗的比例增高（P〈0．05）。术后并发症与患者术前合并症相关。术后一年生存率94．5％,三年生存率76．2％。术后局部复发14人（10．9％）,颈部淋巴结转移9人（7．0％）,远处转移6人（4．7％）,与全年龄组比较差异无统计学意义（P〉0．05）。结论老年喉癌患者术前合并症发生率较高,术后并发症的发生与术前合并症相关。80岁及以上高龄老人晚期喉癌得到根治性手术的机率低。接受合适的治疗后,老年喉癌患者的治疗效果和全年龄组相同。     

Laryngeal sarcocystosis accompanying laryngeal squamous cell carcinoma: case report and literature review

Laryngeal sarcocystosis is an uncommon zoonotic coccidian protozoal infestation of human beings. The authors reviewed the pathology of 1,063 laryngeal biopsies over the past 10 years (2000 to 2009). Only one case of laryngeal sarcocystosis accompanying laryngeal squamous cell carcinoma was identified. The overall prevalence of laryngeal sarcocystosis was 0.094%. The case was a 66-year-old man who presented with voice hoarseness for six months. Physical examination and computed tomography revealed an ulcerative exophytic mass on the right true vocal cord, suggestive of laryngeal carcinoma. He underwent a right frontolateral partial laryngectomy. Histopathology showed a nonkeratinizing squamous cell carcinoma with Sarcocystis spp in the vocalis muscle. He was followed up and enrolled in speech therapy. The authors briefly review the clinicopathologic features and pathogenesis of muscular sarcocystosis and concurrent laryngeal sarcocystosis and squamous cell carcinoma.     

Risk of vocal palsy after thyroidecitomy with identification of the recurrent laryngeal nerve

The purpose of this study was to assess the risk of vocal palsy after thyroidectomy with identification of recurrent laryngeal nerve (RLN) during surgery. In all, 521 patients treated by the same surgeon were enrolled in this study. Temporary and permanent vocal palsy rates were analyzed for patient groups classified according to surgery for primary benign thyroid disease, thyroid cancer, Graves' disease, and reoperation. Measurement of the vocal palsy rate was based on the number of nerves at risk. Twenty-six intentionally sacrificed RLNs were excluded from analysis. Forty patients developed postoperative unilateral vocal palsy. Complete recovery of vocal palsy was documented for 35 of the 37 patients (94.6%) whose RLN integrity had been ensured intraoperatively. Recovery from temporary vocal palsy ranged from 3 days to 4 months (mean, 30.7 days). The overall incidences of temporary and permanent vocal palsy were 5.1% and 0.9%, respectively. The rates of temporary/permanent vocal palsy in groups classified according to underlying disease were 4.0%/0.2% for benign thyroid disease, 2.0%/0.7% for thyroid cancer, 12.0%/1.1% for Graves' disease, and 10.8%/8.1% for reoperation. Surgery for thyroid cancer, Graves' disease, and recurrent goiter were associated with significantly higher vocal palsy rates. Most patients without documented nerve damage during the operation recovered from postoperative vocal palsy. Total lobectomy with routine RLN identification is recommended as a basic procedure in thyroid surgery.     

Ku70蛋白在局部晚期喉癌组织中的表达及与临床病理特征、预后的关系

目的研究Ku70蛋白在局部晚期喉癌组织中的表达及临床意义。方法 选取100例局部晚期喉癌患者治疗前活检标本,应用免疫组化技术检测Ku70蛋白表达情况,并分析其与肿瘤分期、淋巴结转移、生存率等临床病理特征的关系。结果局部晚期喉癌组织中Ku70蛋白过表达率为45％,且其高表达与N分期密切相关（P〈0．01）,与T分期、TNM分期、吸烟、性别无明显相关性;45例Ku70蛋白过表达者及55例低表达者5a生存率分别为37％、58％（P〈0．05）。结论 Ku70蛋白在局部晚期喉癌组织中存在过表达,检测其表达水平对喉癌的个体化治疗、靶向治疗及预后判断有重要参考价值。     

Surgical management of carcinoma of the hypopharynx and cervical esophagus.

Between 1975 and 1988 we observed 169 patients with carcinoma of the cervical esophagus, 85 with a carcinoma involving the hypopharynx and the cervical esophagus, and 27 with a carcinoma of the cervical esophageal region that developed after laryngectomy for laryngeal cancer. The mean age of the patients was 57.5 years (range: 41-73). One hundred and sixty-seven patients underwent surgical exploration (operability rate 59.5%), and in 152 cases the tumor was resected (resectability rate 91.1%). The resection was complete in 129 patients (84.5%) and palliative in 23 (14.5%). In 33 cases a laryngopharyngo-cervical segmental esophagectomy with free intestinal loop transplantation was performed, with an operative mortality of 6.1%. One hundred and three patients underwent laryngo-pharyngo-total esophagectomy, and the digestive tract was reconstructed by means of pharyngo-gastrostomy and pharyngo-colostomy in 85 and 16 cases, with an operative mortality of 12.9% and 18.3%, respectively. Total esophagectomy without laryngectomy was performed in 18 patients with a carcinoma of the distal cervical esophagus who refused laryngectomy, with an hospital mortality of 5.5%. The overall 5-year actuarial survival, excluding the operative mortality, was 15.8%. After complete resection, better results were recorded in patients operated on for carcinoma of the hypopharynx than in patients with carcinoma of the cervical esophagus: the 2-year and 5-year actuarial survival was 59% vs. 26% and 43% vs. 17%, respectively. No patient undergoing palliative resection was alive at the 3-year interval.(ABSTRACT TRUNCATED AT 250 WORDS)     

Laryngopharyngeal reflux in laryngeal cancer.

BACKGROUND/AIMS: Gastropharyngeal or laryngopharyngeal reflux is considered as a factor in various diseases of the larynx and pharynx. The most important consequence of the reflux into the larynx is laryngeal cancer. METHODS: In this prospective study the incidence of gastropharyngeal and laryngopharyngeal reflux in 22 patients with untreated laryngeal cancer was investigated with 24-hour, double probe pH measurements. A group of 25 patients with heartburn and dyspepsia complaints in whom esophagogastroscopy revealed no pathology and for whom 24-hour pH measurement was indicated served as a control group. RESULTS: Two of the 22 patients never smoked and two others had quit smoking 16 and 25 years previously. All four of these patients revealed gastropharyngeal reflux. In total, 14 of the laryngeal cancer patients (63.6%) revealed gastropharyngeal reflux. The rate of gastroesophageal reflux was close among the two groups (50% in the cancer group vs 32% in the control group, p>0.05), but the laryngopharyngeal reflux rate was much higher in the cancer group (63.6% of the cancer patients vs 20% in the control group, p: 0.003). Among the reflux-positive patients and the controls, gastroesophageal reflux rate was higher in the supine position in cancer patients (12.10% vs 6.25, p: 0.02). In the upright position, control cases revealed higher rates of gastroesophageal reflux than the cancer patients. Laryngopharyngeal reflux rates were slightly higher in laryngeal cancer patients than the controls in both upright (9.29% vs 7.67%, p: 0.6) and supine positions (4.83% vs 3.50%, p: 0.6). CONCLUSIONS: Laryngeal cancer patients and patients with heartburn complaints all have a high rate of gastroesophageal reflux. But cancer patients reveal a higher rate of laryngopharyngeal reflux than the symptomatic patients with normal laryngeal findings.     

喉部分切除术患者的发音效果观察

目的观察喉部分切除术患者的发音效果。方法选择行喉部分切除术的患者共118例,评估其发音效果。结果发音效果以喉水平半切除术患者的最好,其后依此为喉裂开术、喉垂直部分切除术、喉3/4切除术患者。不同术式患者的声学参数两两比较,P均〈0.05。结论喉部分切除术患者术后发音效果及嗓音质量以喉水平半切除术者最好。