纤维喉镜检查对喉次全切除咽环吻合术后新喉口的整复作用

为寻求喉次全切除咽环吻合术后，喉的呼吸，吞咽，发声功能恢复的相关因素，对５７例喉次全切除咽环吻合术后不同时期的患者进行１１５次纤维喉镜检查，经摄像拍照对比观察，发现凡新喉口前后径或左右径为７ｍｍ以上，双侧人工披裂占新喉口后缘约１／５范围，梨浆窝形态正常的患者增可顺利除气管套管，发音虽沙哑，但清晰响亮可懂度好，且无吞咽困难。     

影响喉次全切除咽环吻合术后喉功能重建的因素分析

目的观察喉次全切除咽环吻合术后喉功能重建状况及其影响因素.方法对27例喉癌患者施以喉次全切除咽环吻合术,保留会厌及环状软骨,构制人工披裂和梨状窝,术后分阶段纤维喉镜录相系统观察.结果27例术后全部重建较理想的喉功能.结论环状软骨在新喉腔的塑形中起着至关重要的作用,咽缩肌在新喉口发挥了括约功能,术中应避免过多分离损伤.     

中段喉次全切除术

报告对17例喉癌(Ⅱ期12例,Ⅲ期5例)行中段喉次全切除术。10例经3年以上随访,7例已无瘤生存6～8年,2例无瘤生存3～4年,1例复发死亡;9例拔除了气管插管。提示:选择适当的喉癌病例行中段喉次全切除术,可以使一些过去必须行全喉切除的病例得以只切除3/4或4/5的喉组织,既彻底切除了肿瘤又保存了喉功能,从而扩大了喉部分切除术的适应证。     

应用纤维喉镜诊治喉咽异物

目的探讨喉咽部隐匿性、细小异物的治疗方法.方法对21例异物史明确,常规方法无法窥及或取出困难的患者行纤维喉镜检查.结果21例均一次发现异物并钳取成功.结论纤维喉镜诊治喉咽部隐匿性及可疑异物创伤小,成功率高.     

纤维喉镜下用间接喉钳异物取出的体会

喉咽部异物是耳鼻咽喉科常见的急症.多采用间接喉镜、直接喉镜或纤维喉镜下行异物取出术;上述方法均各有不足之处.我科自1997年5月～2001年12月对取出较困难的咽喉异物病例,采用日产Olympus ENF-T3型纤维喉镜下间接喉钳异物取出术,获得了较好的效果,报告如下.     

喉近全切除后发音重建术

自１９９０年以来,对晚期喉癌及喉咽癌患者行喉近全切除发音重建术１６例,效果良好。１资料与方法１１临床资料本组１６例患者,男１４例、女２例,年龄５１～７３岁,平均５８岁。其中喉癌１２例、下咽癌４例,病理诊断均为鳞状细胞癌。按照ＵＩＣＣ１９８７年标准分...     

纤维喉镜及弯头喉钳在支撑喉镜手术声门暴露不全时的联合应用

自 1991年 4月～ 2 0 0 2年 6月 ,共对 5 5 4例声带新生物患者行支撑喉镜下手术摘除或取活检 ,对其中 3例声带病变暴露困难者 ,于术中联合应用纤维喉镜、弯头喉钳顺利摘除。报告如下 :1　资料与方法1.1　临床资料支撑喉镜下声带手术中声门暴露不全患者 3例 ,均为男性 ,年龄为 4 1～ 4 7岁。声嘶明显 ,病程 3个月～ 2年。体态矮胖 ,颈部粗短 ,体格健壮。术前间接喉镜检查声门暴露不清 ,纤维喉镜检查见新生物位于近前联合处。 1例约绿豆大小 ,2例约半粒黄豆大小 ,表面较光滑。术后病检均为息肉。1.2　方法术前经全身体检及有关辅助检查 ,无手…     

纤维喉镜在喉喘鸣诊断中的应用

目的:探讨纤维喉镜在喉喘鸣诊断中的应用价值.方法:回顾性分析130例以喉喘鸣为主要症状就诊的患儿的临床资料.130例患儿均接受纤维喉镜检查.结果:经纤维喉镜检查发现,130例患儿中先天性喉喘鸣73例,先大性喉噗2例,会厌囊肿5例,舌根部囊肿或肿块20例,喉气囊肿1例,喉乳头状瘤3例.一侧或舣侧披裂关节活动差9例.未发现任何异常17例.结论:单纯先灭性喉喘鸣易误诊,必须排除其他引起喉喘呜的疾病.建议将纤维喉镜作为喉喘呜患儿就诊时必须的常规检查,必要时可辅助喉部CT和(或)MRI检查.     

环状软骨上部分喉切除及功能重建术疗效观察

目的探讨环状软骨上部分喉切除及功能重建术的适应证及疗效.方法回顾性研究1997年～2001年期间施行环状软骨上部分切除及功能重建术治疗的17例喉声门癌患者资料. 结果 17例患者均于术后7～16天拔除气管套管,平均11天;术后8～18天拔除鼻饲管,平均15天,拔管率100%.全部病例术后恢复了喉的三大功能.术后3年17例患者均存活,其中5年以上无瘤生存者11例. 结论该术式能在切除癌肿的同时更加有效地恢复喉功能,改善生存质量.     

水平垂直部分喉切除术的临床观察

目的观察水平垂直部分喉切除术的治疗效果。方法总结2000～2006年采用水平垂直部分喉切除术治疗的36例喉癌患者,分析其生存率和喉功能保留情况。结果本组病例3年生存率80.6%,5年生存率为78.8%。死亡病例中除失访3例外;另外7例死亡病例中,死于局部复发2例、死于颈部淋巴结转移2例、死于肺转移1例、死于大出血1例、死于骨转移1例。本组患者均保留了发音功能,35例患者拔管,拔管率为97.2%,经过功能训练,患者均可经口进食。结论在严格掌握适应证的情况下,水平垂直部分喉切除术能够在保留喉功能的同时根治肿瘤。     

Laryngeal function-preserving operation for T4a laryngeal cancer with vocal cord paralysis — A case report

For locally advanced laryngeal cancers, the standard treatment of choice is chemoradiotherapy if organ function needs to be conserved. Surgical treatment with larynx preservation is conducted only for limited cases. For locally advanced laryngeal cancers such as those with vocal cord fixation and/or cricoid cartilage destruction, there is no apparent standardized organ-preserving surgery keeping the essential laryngeal functions, viz. the airway, deglutition and articulation, uncompromized.Recently, our surgical team saw a patient with T4a advanced laryngeal cancer with vocal cord fixation who aspired to maintain his laryngeal function. Driven by his eagerness, we contrived novel techniques for laryngeal function preservation and performed a two-staged operation.In the first stage, extended vertical partial laryngectomy was conducted including resection of the affected thyroid, arytenoid, and cricoid cartilages, followed by local closure of the hypopharynx. Additionally, laryngeal suspension surgery and cricopharyngeal myotomy were performed in addition to suturing the epiglottis with the intact arytenoid cartilage to enhance swallowing function. In the second stage, airway reconstruction was performed using a local skin flap.As of 10 months after operation, there has been no tumor recurrence, and the reconstructed larynx has been working satisfactorily.In this report we describe an innovative operation that was especially contrived for laryngeal function preservation.     

Supracricoid partial laryngectomy with cricohyoidoepiglottopexy and cricohyoidopexy for glottic and supraglottic carcinomas

OBJECTIVES: To review the patients operated in our department with supracricoid partial laryngectomy with either cricohyoidoepiglottopexy (CHEP) (59 cases) or cricohyoidopexy (CHP) (10 cases) technique, for primary or recurrent glottosupraglottic squamous cell carcinoma and compare the technique with other surgical or conservative approaches for treatment of laryngeal carcinoma. METHODS: From hospital charts, we retrospectively reviewed 69 patients who had undergone supracricoid partial laryngectomy with the CHEP or CHP technique between 1983 and 1996 for primary or recurrent glottosupraglottic squamous cell carcinoma in our department. Statistical evaluation of oncological and functional results were conducted. Results were compared with other surgical and conservative treatment for glottosupraglottic carcinoma of the larynx that were published previously in the literature. RESULTS: Sixty-nine patients had CHEP or CHP for glottosupraglottic carcinoma of the larynx. Thirteen percent of the patients received adjuvant radiotherapy. Minimum follow-up was 2 years or until death. Five-year actuarial survival (Kaplan-Meier method) was 68%. Global local control was achieved in 84% of cases. Among previously untreated patients (n = 54), local control rate was 94.5%. After 1 year, 92.7% of patients achieved normal swallowing and respiration. Salvage total laryngectomy had to be performed in four patients (5.7%) for persistent aspiration and in five patients (7.2%), who were previously treated with radiotherapy, for local recurrence. No permanent tracheostomy or gastrostomy was required. CONCLUSIONS: Our experience with supracricoid partial laryngectomy with either CHP or CHEP suggests that this technique is a valuable alternative to radiotherapy for T2-T4 glottosupraglottic carcinomas, particularly those with extension and invasion of the anterior commissure. It allows for preservation of a good laryngeal function without altering the long-term survival, keeping total laryngectomy as a salvage procedure.     

T3声门型喉癌手术疗效分析

目的评价喉部分切除术与全喉切除术治疗T3声门型喉癌的疗效.方法回顾性分析我院1990年1月～1999年12月对43例T3声门型喉癌行喉部分切除术与全喉切除术的临床资料,比较两种术式的疗效.结果喉部分切除术17例,5年生存率76.47%;全喉切除术26例,5年生存率69.23%,两组间疗效差异无显著性意义(P>0.05).结论部分T3声门型喉癌患者行喉部分切除术是可行的.     

Functional Analysis After Supracricoid Partial Laryngectomy With Cricohyoidoepiglottopexy

Objectives To assess prospectively speech and swallowing function in a series of 17 patients after supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Study Design Retrospective study. Methods From 1983 to 1996, 69 patients at Department of Otolaryngology—Head and Neck Surgery, CHUV (Lausanne, Switzerland) underwent a supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Seventeen of them (25%) could be contacted and accepted participation in a functional evaluation that included a questionnaire to document their present nutritional status and diet. A formal voice evaluation was also performed, which included psychoacoustic evaluation of vocal qualities, fundamental frequency parameters, phonation intensity range, phonatory quotient (vital capacity divided by maximum phonation time), and a laryngeal video laryngoscopy performed with a rigid endoscope. Results Median postoperative follow‐up was 66 months (range, 12–152 mo). Nine of 17 patients (53%) recovered a normal diet with no increased incidence of aspirations. Seven of 17 had minor limitations such as no peanuts, dry bread, or rice. Two of 17 patients were restricted to pureed food. Assessment of voice showed a clearly decreased mean fundamental frequency at 70.1 Hz (normal range, 121–211 Hz) and a narrowed frequency range of phonation with a mean value of 8.8 semitones (normal value, 27). Forty‐two percent of the patients went back to their normal professional life after the operation. Among the 10 who did not, 3 (16%) retired and 7 actually had to give up their profession, because of the modification of their voice or general asthenia and age close to retirement. Conclusion Restoration of laryngeal function after supracricoid partial laryngectomy with cricohyoidoepiglottopexy is satisfactory. Although most of the patients seem to recover normal swallowing function, severe voice alterations appear to be inevitable.     

Clinical experiences with surgical techniques and treatment results in patients undergoing subtotal laryngectomies

After a period of critical evaluation, subtotal laryngectomies are now considered to be valuable additions to the surgical management of laryngeal neoplasms. It is now possible to obtain good functional and oncological results in treating clinical situations that until a few years ago appeared curable only by radical surgery. We now report our clinical experiences with Labayle and Majer-Piquet types of subtotal laryngectomies and discuss indications and contra-indications to such surgery. Our current preference is to use the Labayle technique, since it permits better functional recovery and a shorter clinical course.     

梨状窝粘膜修复喉部分切除术后的粘膜缺损

目的 :探讨应用梨状窝粘膜修复喉部分切除术后粘膜缺损及恢复喉功能的效果。方法 :对 198例患者施行此术式 ,其中喉水平部分切除术 87例、喉垂直部分或扩大喉垂直部分切除术 6 5例、喉水平加垂直部分切除术 4 6例。同时进行随访观察。结果 :喉水平部分切除术者拔管率为 10 0 % ;术后发音、呼吸、吞咽功能恢复好 ;5年生存率为 84 .7%。喉垂直部分或扩大喉垂直部分切除术拔管率为 87.7% ;5年生存率 86 .2 % ;术后吞咽、呼吸功能恢复好 ,但有声音嘶哑。喉水平加垂直部分切除术后初期进食呛咳较重 ,训练适应时间较长 ,拔管率为82 .6 % ;5年生存率为 78.3% ;术后声音嘶哑 ,部分患者喉狭窄导致拔管困难。结论 :本方法操作简单 ,取材方便 ,手术时间较短 ,成活率高 ,术后喉功能保留好 ,患者的 5年生存率高。     

Evaluation of voice and speech following subtotal reconstructive laryngectomy

Subtotal reconstructive laryngectomy (SRL) can be used to preserve voice in the treatment of selected laryngeal carcinomas. This study was designed to analyze both voice and speech results achieved after SRL in 14 male patients, aged from 48 to 73 years. Surgery was performed between 1983 and 1993. Fundamental frequencies, ranges of frequency, intensities, and intensity ranges were established using an S.I. 80 Philips AAC 600 Audio Active Comparative Language System. Five prolonged vowels and six phonetically balanced sentences were recorded on a tape positioned at a distance of 30 cm from the mouth of each patient during a 3-min recording time. The recorded material was then evaluated by a panel of ten trained listeners who were asked to consider the qualitative parameters and perceptual characteristics of voice and speech according to a scorecard modified from one devised by Voiers and Formigoni. Although a decrease was determined in Fundamental Frequency and intensity of the voice when compared to normal values, the quality and perception of speech were found to be satisfactory. The verbal message could be understood almost exactly by means of constant sonority, correct articulation and improved pneumophonic coordination. These values demonstrate that the new voice achieved after SRL is less sonorous and allows for understandable and socially acceptable speech. Received: 10 April 1996 / Accepted: 19 September 1997