保留甲状软骨的喉部分切除术疗效分析

发布时间：2018-03-30 05:06

本文选题：喉肿瘤　切入点：喉切除术　出处：《大连医科大学》2011年硕士论文

【摘要】：目的:比较保留甲状软骨的喉部分切除术与传统喉部分切除术在治疗声门型喉癌中的效果,探讨保留甲状软骨的喉部分切除术的可行性及术后喉功能恢复情况。方法:回顾性分析1999年1月～2007年1月大连医科大学附属一院耳鼻喉科收治的初治声门型喉癌患者128例,术中肉眼和病理证实甲状软骨内膜无癌细胞侵犯或甲状软骨局灶性破坏无需大范围切除的T2-3期病例,采用病例对照研究方法,按部位相同、TNM分期相同,年龄相差≤10岁,1:1配对。研究组为保留甲状软骨的喉部分切除术患者,共64例,其中T2N0 38例,T2N1 6例,T2N2 1例,T3N0 17例,T3N1 2例;对照组为传统喉部分切除术患者,共64例,TNM分期同上。比较两组患者生存率、局部控制率和拔管率。结果:保留甲状软骨的喉部分切除术组3年及5年累积生存率分别为89.8%、84.3%,对照组分别为91.5%、85.4%,统计学分析显示差异无统计学意义(χ2=1.687,P0.05);保留甲状软骨的喉部分切除术组局部控制率为91.7%(55/60),对照组为93.2%(55/59),统计学分析显示差异无统计学意义(χ2=0.103,P0.05);保留甲状软骨的喉部分切除术组拔管率为98.3%(59/60),对照组为88.1%(53/59),统计学分析显示两组差异有统计学意义(χ2=4.933,P0.05),保留甲状软骨的喉部分切除术组的拔管率明显优于对照组。结论:关于T2期和部分T3期声门型喉癌患者的治疗,与传统喉部分切除术式相比,保留甲状软骨的喉部分切除术在保证彻底切除肿瘤、保留足够安全缘的同时,保留了喉功能,其术后拔管率高,并发症发生率低,有助于改善喉癌患者术后的生活质量。在根治肿瘤、保留喉功能和防止并发症方面有显著效果,且术式简单,在严格掌握手术适应症的同时可以广泛应用。
[Abstract]:Objective: to compare the effect of partial laryngectomy with preservation of thyroid cartilage and traditional partial laryngectomy in the treatment of glottic laryngeal carcinoma, and to explore the feasibility of partial laryngectomy with preservation of thyroid cartilage and the recovery of laryngeal function after operation. Methods: from January 1999 to January 2007, 128 patients with newly diagnosed glottic laryngeal carcinoma were treated in the Department of Otorhinolaryngology, first affiliated Hospital of Dalian Medical University. Stage T2-3 cases with no invasion of cancer cells or focal destruction of thyroid cartilage without extensive resection were confirmed by naked eye and pathology during the operation. The stage of TNM was the same according to the same site, using a case-control study. There were 64 cases of partial laryngectomy with preservation of thyroid cartilage in study group, including 38 cases of T2N0 with T2N1 6 cases of T2N2 and 1 case of T3N0 17 cases of T3N1, and the control group of 2 cases of traditional partial laryngectomy. The survival rate, local control rate and extubation rate were compared between the two groups. Results: the 3-year and 5-year cumulative survival rates of partial laryngectomy group with thyroid cartilage preservation were 89.8% and 84.3%, respectively, while those of control group were 91.5% and 85.4%, respectively. Statistical analysis showed that there was no significant difference (蠂 2 1.687% P 0.05; partial laryngectomy group with preservation of thyroid cartilage). The rate of partial control was 91.7% 55 / 60 and that of the control group 93.22.55% 59%. The statistical analysis showed no statistical significance (蠂 2 / 0.103% P 0.05); the rate of extubation in partial laryngectomy group with preserving thyroid cartilage was 98.3% of 59 / 60%, and that in control group was 88.1% 53 / 59%. The statistical analysis showed that the difference between the two groups was statistically significant (蠂 2 / 4.93% P 0.05N, P 0.05). The extubation rate of partial laryngectomy group with thyroid cartilage was significantly higher than that of control group. Conclusion: compared with traditional partial laryngectomy, partial laryngectomy with thyroid cartilage preservation in patients with glottic laryngeal carcinoma at stage T2 and part T3 can ensure complete resection of the tumor and sufficient safety margin. The laryngeal function is preserved, the rate of extubation is high and the incidence of complications is low. It is helpful to improve the quality of life of the patients with laryngeal cancer after operation. It has remarkable effect in radical cure of tumor, preservation of laryngeal function and prevention of complications, and the method of operation is simple. It can be widely used at the same time of strictly mastering the indication of operation.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.65

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