Supracricoid laryngectomy with cricohyoidoepiglotto-pexy or cricohyoido-pexy: Experience on 32 patients
Supracricoid laryngectomy with cricohyoidoepiglotto-pexy or cricohyoido-pexy: Experience on 32 patients
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DOI：
10.1016/j.anl.2007.04.018
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发表时间：
2008-03-01
影响因子：
1.7
通讯作者：
Seino, Yutomo
中科院分区：
文献类型：
--
作者：
Nakayama, Meijin;Okamoto, Makito;Seino, Yutomo
目的环状软骨上喉切除术（SCL）联合环舌骨肌会厌固定术（CHEP）或环舌骨肌固定术（CHP）是治疗早期和中晚期喉癌的一种保留器官的手术。为验证环状软骨上喉切除术与全喉切除术的临床疗效，对1997-2005年32例环状软骨上喉切除术患者的临床及术后资料进行回顾性分析。结果12例（38%）患者术后出现切口感染，29例（39/35）患者行全喉切除术，35例（35/35）患者行全喉切除术。那些严重感染，需要手术干预，包括两例破裂pexis和两例显示环状软骨坏死引起的福雷斯蒂埃病。有2例T4病例导致广泛切除。在1例病例中，切除涉及环状软骨的后部，导致新声门闭合不充分;由于持续吸入流质饮食，患者在SCL-CHEP后30个月接受全喉切除术。在另一个T4病例中，肿瘤侵犯了甲状软骨和杓状软骨，但没有侵犯环状软骨。重新定位剩余的小角软骨导致新声门充分闭合，该患者随后获得了令人满意的喉功能。SCL组的5年总生存率为86%，全喉切除术组为61%（仅限于III期和IV期声门癌）。4例死亡原因分别为远处转移、颈部转移和并发症。结论SCL在功能和肿瘤学方面的疗效优于全喉切除术。特别是，SCL-CHEP的临床影响令人印象深刻;这项技术需要推荐给头颈外科医生和患者。(c)2007爱思唯尔爱尔兰有限公司保留所有权利。
Objective Supracricoid laryngectomy (SCL) with Cricohyoidoepiglotto-pexy (CHEP) or Cricohyoido-pexy (CHP) is an organ preservation surgery indicated for early and selected advanced laryngeal cancers. To verify the clinical usefulness of supracricoid laryngectomy versus total laryngectomy, a retrospective review was conducted.Methods We summarized the clinical and postoperative data of 32 patients who received SCL over the past 9 years (1997-2005). Five-year survival rate of the SCL patient group (29 cases) was compared with that of the patient group receiving total laryngectomy (35 cases) within the same period.Results Wound infection was detected in 12 patients (38%). Those with severe infection, which required surgical intervention, included two cases of ruptured pexis and two cases showing cricoid cartilage necrosis induced by Forestier disease. There were two T4 cases that resulted in extensive excision. In one case, excision involved the posterior part of the cricoid cartilage resulting in insufficient closure of the neoglottis; the patient received total laryngectomy 30 months after SCL-CHEP because of persistent aspiration of liquid diet. In the other T4 case, the tumor invaded the thyroid and arytenoid cartilages but not the cricoid cartilage. Reposition of the remaining corniculate cartilage resulted in sufficient closure of the neoglottis; this patient subsequently acquired satisfactory laryngeal function. The 5-year overall survival rate was 86% for SCL group and 61% for the total laryngectomy group (limited to Stages III and IV glottic cancers). The causes of the four deaths were distant metastasis, neck metastasis, and intercurrent disease, respectively. Two patients are alive with distant disease.Conclusion Through our experience in this series, the functional and oncological results of SCL showed certain advantages over those of total laryngectomy. Particularly, the clinical impact of SCL-CHEP was impressive; this technique needs is recommended to both head and neck surgeons and patients. (c) 2007 Elsevier Ireland Ltd. All rights reserved.