声门上型喉癌术后改良修复法在老年患者中的应用

目的 探讨老年患者声门上型喉癌术后修复方法的改良及其喉功能保留效果。方法 回顾性分析2007年1月—2012年12月,安徽医科大学第一、第四附属医院耳鼻咽喉头颈外科收治的35例声门上型喉癌老年患者的临床资料。其中男34例、女1例,年龄65～75岁,均行喉功能保留手术治疗。原发病灶位于一侧声门上者行保留对侧喉上神经声门上部分喉切除,原发病灶位于声门上中间者行不同部分的声门上部分喉切除;然后,采用颈前带状肌延长舌根方法修复或小喉成型方法进行咽喉功能重建。术后观察患者喉功能恢复情况及3年、5年生存率。结果 35例患者术后10 d～3个月逐步恢复发音,其中32例发音良好,另外3例发音嘶哑;术后第10天试饮水,其中30例无明显呛咳后进食半流质,5例呛咳明显者经功能锻炼3个月后进食呛咳基本消失。33例于术后15天到3个月拔管,拔管率94.29%(33/35)。无一例并发严重肺部感染。35例中,随访满3年者32例,失访3例。32例中,5例在术后12～18个月复发,行全喉切除术;4例在术后20～32个月死于喉癌复发,2例术后18、23个月死于其他疾病;3年生存率为81.25%(26/32)。随访满5年者19例,失访5例,术后未满5年11例。随访5年的19例中,6例分别于术后20～54个月死于喉癌复发,3例术后18～56个月死于其他疾病,5年生存率为10/19。结论 老年人声门上型喉癌术后可通过改良修复方法加快发音和吞咽功能的恢复,从而最大限度地减少误吸。

Application of improved reparation after surgery for gerontal supraglottic laryngeal carcinoma

Objective To investigate the efficiency of improved reparation after surgery for gerontal supraglottic laryngeal carcinoma.Methods A retrospective review of 35 patients with supraglottic carcinoma which conservation surgeries were performed from January 2007 to December 2012 in the Department of Otolaryngology Head Neck surgery of the First Affiliated Hospital of Anhui Medical University and the Fourth Affiliated Hospital of Anhui Medical University. Thirty-five patients including 34 males and 1 female with age from 65 to 75 years underwent conservation surgery of laryngeal function for larygeal carcinoma. To reserve one side recurrent laryngeal nerve and lengthen root of tongue, small larynx forming were used in 35 patients to reconstruct the defect.Results All of the 35 patients had their phonation restored from 10 days to 3 months, with 32 patients well and other 3 hoarseness.There were 30 patients eating semifluid 10 days after operation,the other 5 patients with hard bucking got well after 3 months functional exercise.Thirty-three patients had been pulled out their tracheal casing pipe from 15 days to 3 months after operation with a decannulation rate of 94.29%(33/35) . No patient had complications of pulmonary infection. The 3-year and 5-year survival rates were 81.25% (26/32)and 10/19, respectively.Conclusions Function of deglutition and phonation will accelerate after improved the reparation of gerontal supraglottic laryngeal carcinoma defect, postoperative complications will decrease.