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目的:探讨喉全切除术治疗中、晚期喉癌的疗效。方法:对573例喉癌患者行喉全切除术,声门上型370例,声门型90例,跨声门型75例,声门下型21例,放疗后复发17例。其中143例行单纯喉全切除术,430例同期行颈廓清术(单侧239例,双侧191例)。在喉全切除术中行气管外口造大孔术,共308例。结果:3、5及10年生存率分别为69.5%(398/573),61.1%(350/573),46.3%(149/322);220例死亡病例中,45.0%(99/220)死于局部复发;22.3%(49/220)死于颈部转移。术腔感染和咽瘘的发生率分别为12.2%,5.2%。16.6%气管外口造大孔术患者气管外口再度狭窄需行Ⅱ期气管外口扩大术或戴套管维持呼吸。13.6%的患者可以行喉部分切除术,由于不同的原因行喉全切除术。结论:喉全切除术作为治疗中、晚期喉癌的主要手段,其适应证随喉癌外科技术的发展而逐渐缩小。在采取积极的颈廓清术情况下,局部复发是主要的死亡原因。
Objective: To investigate the effect of total laryngectomy in the treatment of advanced laryngeal carcinoma. Methods: 573 cases of laryngeal cancer patients underwent total laryngectomy, 370 cases of supraglottic, 90 cases of glottis, 75 cases of transglottic, 21 cases of subglottic and 17 cases of recurrence after radiotherapy. One hundred and forty-three cases underwent simple total laryngectomy and 430 cases underwent neck dissection at the same period (239 cases of unilateral, 191 cases of bilateral). In the total laryngectomy tracheostomy for macrophora, a total of 308 cases. Results: The 3,5 and 10 year survival rates were 69.5% (398/573), 61.1% (350/573) and 46.3% (149/322), respectively. Of the 220 deaths, 45.0% (99/220) died Local recurrence; 22.3% (49/220) died of cervical metastasis. The incidence of infection and pharyngeal fistula surgery were 12.2%, 5.2%. 16.6% of patients with tracheostomy macrophages outside the tracheal stenosis need to be stenosed Ⅱ endotracheal extension or wearing a tube to maintain breathing. Thyroidectomy was performed in 13.6% of patients and total laryngectomy for different reasons. Conclusion: Total laryngectomy as the main treatment for advanced laryngeal cancer, its indications with the development of laryngeal surgery and gradually reduced. Local recurrence is the main cause of death when aggressive nephro-nephrosis is adopted.