保留喉功能的T3期声门上喉癌的手术治疗

目的：探讨T3期声门上喉癌喉功能保留手术的可行性、技术操作和临床疗效。方法：回顾性分析1994～2003年收治的T3期声门上癌70例，均行喉功能保留手术，其中喉声门上水平部分切除术42例，喉声门上水平垂直部分切除术19例，喉环状软骨上部分切除术8例，喉近全切除术1例。以胸骨舌骨肌肌筋膜瓣、颈阔肌肌皮瓣、双蒂接力肌甲状软骨膜瓣、甲状软骨膜瓣等修复喉腔组织缺损，重建喉功能。全部患者均接受术后放疗（剂量50～60Gy）。结果：3年生存率为79．2％，5年生存率为68．4％。70例患者中已拔管60例，拔管率为85．7％。全部患者均恢复经口进食，无明显呛咳及吞咽困难。所有患者均发声成功，无一例因喉腔闭锁而致发声失败。结论：T3期声门上癌虽属晚期喉癌，但只要严格掌握适应证，熟练运用多种修复方法，提高外科手术技巧，保留喉功能是可行的。

Preservation of laryngeal function in surgical treatment of T3 supraglottic laryngeal carcinoma

Objective:To explore the feasibility,surgical techniques and the clinical curative effect of preservation of laryngeal function in surgical treatment of T_3 supraglottic laryngeal carcinoma(SLC).Method:A retrospective review of 70 cases with T_3 SLC that we treated from 1994 to 2003 were accomplished.All of the cases were treated with partial laryngectomy. Among them,42 cases underwent supraglottic horizontal partial laryngectomy , 19supraglottic horizontovertical laryngectomy, 8 supracricoid partial laryngectomy and 1near total laryngectomy.All patients were received postoperation radiotherapy with the dosage for 50~60 Gy.Result:The 3 year and 5 year- survival rates were 79.2% and 68.4%, respectively. Out of the 70 cases, 60 cases were decannulated with a de-cannulation rate of 85 .7 %. The normal diet was resumedin all patients ,no bucking and dysphagia obviously .Allpatients had their successful phonation,no one failure for laryngotracheal atresia .Conclusion :It is feasibility to pr-eservate laryngeal function in surgical treat ment of T3SLC,if surgeons master indications correctly , use manykinds restorative procedure expertly and i mprove surgical skill .