摘要目的 分析环状软骨上部分喉切除术(supracricoid partial laryngectomy,SCPL)治疗喉癌的远期疗效.方法 回顾性分析2005年1月至2013年12月在复旦大学附属眼耳鼻喉科医院头颈外科接受SCPL治疗的298例喉癌患者的临床资料,并对术后生存率、局部控制率、功能恢复、并发症和复发转移等数据使用SPSS 23.0软件进行统计学分析.结果 267例声门型喉癌患者主要接受环状软骨舌骨会厌固定术(cricohyoidoepiglottopexy,CHEP)治疗,31例声门上型喉癌患者主要接受环状软骨舌骨固定术(cricohyoidopexy,CHP)治疗.平均随访74个月(12 ~146个月),死亡54例(18.1%).声门上型喉癌患者的5年和10年总生存率和疾病特异性生存率均为78.1%,5年和10年无病生存率分别为72.1%和63.7%,5年和10年局部控制率均为84.2%.声门型喉癌患者的5年和10年总生存率分别为85.8%和77.1%,5年和10年疾病特异性生存率分别为86.6%和78.4%,5年和10年无病生存率分别为80.6%和74.2%,5年和10年局部控制率分别为90.0%和89.4%.T1的声门型喉癌患者的生存率要高于T2和T3患者,早期声门型喉癌患者的无病生存率高于进展期患者.Cox多因素分析提示T2、T3期和肿瘤复发转移是影响患者术后生存率的独立危险因素.此外,术后鼻饲管的拔管率为100%,气管套管拔管率为96%.结论 SCPL能够完整地切除喉癌组织,保留患者较好的吞咽、呼吸和发音功能,具有较满意的远期生存率和局部控制率.SCPL可作为标准的手术方案治疗经选择的T1b-T3期声门上型和声门型喉癌.

abstractsObjective To evaluate the oncologic and functional outcomes of supracricoid partial laryngectomy(SCPL)in the treatment of laryngeal carcinoma.Methods A total of 298 laryngeal carcinoma patients who underwent SCPL treatment from January 2005 to December 2013 were reviewed retrospectively. Clinical data of demographic and clinical characteristics, postoperative complications, rehabilitation information,recurrence and metastasis were analysed.Survival and local control were used to evaluate the clinical outcome.Data were analyzed by SPSS 23.0 software.Results Thirty-one patients with supraglottic carcinoma underwent cricohyoidoepiglottopexy (CHEP)and 267 with glottic carcinoma underwent cricohyoidopexy(CHP)were enrolled in this study.The mean duration of followed up was 74 months, ranging from 12 to 146 months.Fifty-four cases died at last follow-up.With respect to 31 patients with supraglottic carcinoma, 5-and 10-year overall survival rates and disease specific survival rates all were 78.1%;5-and 10-year disease free survival rates were 72.1% and 63.7% respectively; and 5-and 10-year local control rates were both 84.2%.In 267 patients with glottic carcinoma, 5-and 10-year overall survival rates were 85.8% and 77.1% respectively; 5-and 10-year disease specific survival rates were 86.6% and 78.4% respectively; 5-and 10-year disease free survival rates were 80.6% and 74.2%respectively;and 5-and 10-year local control rates were 90.0%and 89.4%respectively.The survival rate of patients with glottic carcinoma at stage T 1 was higher than that at stage T2 or T3, and the disease free survival rate of patients with early stage was superior than that of patients with advance stage.Cox regression analysis showed that tumor stage T 2,and T3,tumor recurrence,and tumor metastasis were independent risk factors for survival.Furthermore, nasogastric feeding tube removal rate was 100% and the decannulation rates of SCPL were 96% in the patients with SCPL.Conclusions SCPL is a safe procedure with tumor resection for laryngeal carcinoma,with preserving of swallowing, respiration,and phonation functions,and has excellent survival and local control rates.This procedure could be considered as a standard function-sparing treatment for selected patients with laryngeal carcinoma of stages T1b-T3.