喉微创术与喉环状软骨上切除术治疗部分早期声门型喉癌的疗效观察

发布时间：2018-03-18 06:04

本文选题：声门型喉癌　切入点：环状软骨上喉部分切除术　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:对比分析喉微创术和环状软骨上部分切除术对于符合适应症的部分早期声门型喉癌的疗效及其他预后差异,为此类患者的治疗提供依据。方法:搜集我院自2007年1月-2011年12月5年间收治、病理诊断明确(术前病理或术中快速病理),并于我科行喉微创手术或环状软骨上喉部分切除术的早期声门型喉癌患者47例(其中行喉微创术患者24例记为A组,环状软骨上喉部分切除术患者23例记为B组),查阅病历并进行随访(电话随访或门诊复诊时随访)。先对2组整体的术后转归的几个独立因素用卡方检验、非参数秩和检验进行单变量分析。再对不同手术方式对2组患者的住院时间、手术时间、住院费用等的影响进行对比分析,根据结果评估2种术式的临床疗效。P0.05具有统计学意义。结果:A组24例失访2例,B组23例失访2例,均不列入统计分析数据。获得随访的43例患者,A组术后随访时间月37个月-119个月,平均随访时间90.2个月,B组随访时间跨度范围27个月到116个月,平均为79.8个月。A组术后5年生存率90.9%,B组为90.5%。对于本文调查的T1b N0M0期声门型喉癌,未发现有统计学意义,影响患者预后的单变量,但调查显示术后复发的患者术后生存时间较未复者明显缩短,且本文资料均为5年内复发,复发者中死亡率80%(5例复发,4例死亡),4例均于术后5年内死亡,结果都为局部病灶或淋巴结复发。2组患者的住院时间、住院期间费用采用非参数检验、手术时间用t检验的对比,发现喉显微即微创手术比开放性喉环状软骨上部分切除手术可以较大程度的减少住院、手术时间和住院费用,P0.05,具有统计学意义。结论:喉微创手术和环状软骨上喉部分切除术均在较好的肿瘤治疗效果的基础上最大限度地保留了喉的呼吸、发音、吞咽等生理功能,使患者术后维持较好的生活和心理状态。作为最近几年发展迅速的一种术式,喉微创术相比喉环状软骨上部分切除术有相似的肿瘤治疗效果,但无需气管切开、颈部无切口,手术时间短,术后正常进食,住院时间明显缩短、住院费用相对较低;术后均无误吸,恢复快,具有更加优越的疗效,在严格掌握适应症的情况下,值得临床推广。
[Abstract]:Objective: to compare and analyze the curative effect and other prognostic differences of laryngeal minimally invasive laryngectomy and annular suprachondral partial resection for partial early glottic laryngeal carcinoma in accordance with the indication. Methods: from January 2007 to December 5th 2011, the patients were collected and treated in our hospital. 47 patients with early glottic laryngeal carcinoma underwent laryngeal minimally invasive laryngectomy or partial laryngectomy with annular suprachondral laryngectomy (including 24 patients with laryngeal minimally invasive laryngectomy as group A). Twenty-three patients with partial ring-chondroid laryngectomy were recorded as group B, and their medical records were consulted and followed up (telephone follow-up or out-patient follow-up). Chi-square test was used to test several independent factors of the overall postoperative outcome in both groups. The non-parametric rank sum test was used for univariate analysis. The effects of different surgical methods on the hospitalization time, operation time and hospitalization cost of the two groups were compared and analyzed. Results there were 24 cases of missing visit in group A, 2 cases in group B, 2 cases in group B, 2 cases in group B, 2 cases in group B, 2 cases in group B, 2 cases in group B, 2 cases in group B, and 2 cases in group B. 43 patients in group A were followed up from 37 months to 119 months, and the mean follow-up time was 90.2 months. The follow-up time of group B ranged from 27 months to 116 months. The average 5-year survival rate of group A was 79.8 months. The 5-year survival rate of group B was 90.5. There was no significant single variable for stage T1b N0M0 glottic laryngeal carcinoma investigated in this paper. However, the investigation showed that the survival time of the patients with postoperative recurrence was shorter than that of the patients without recurrence, and the data in this paper were all recurrence within 5 years. The mortality rate of the patients with recurrence was 80%, 5 cases with recurrence and 4 cases with death, and 4 cases died within 5 years after operation. The results showed that the hospitalization time of the patients with local focus or lymph node recurrence in group 2, the cost of hospitalization was nonparametric test, and the operation time was compared with t test. It was found that laryngeal microsurgery, or minimally invasive laryngotomy, could reduce hospitalization to a greater extent than open partial laryngeal ring-chondroidectomy. Conclusion: minimally invasive laryngectomy and partial laryngectomy of annular suprachondral laryngectomy can preserve the physiological functions of larynx, such as breathing, pronunciation, swallowing and so on, on the basis of better therapeutic effect of tumor. As a rapidly developing procedure in recent years, laryngeal minimally invasive laryngectomy has a similar effect on tumor treatment compared with partial laryngeal annular suprachondral resection, but without tracheotomy and neck incision. The operation time is short, the postoperative normal food intake, the hospitalization time is obviously shortened, the cost of hospitalization is relatively low; all the patients are inerrant after operation, recover quickly, have more superior curative effect, under the condition of strictly grasping the indication, it is worth popularizing in clinic.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.65

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