以垂直式部分喉切除術治療放射線治療後復發之早期聲門癌的長期經驗

Salvage Vertical Partial Laryngectomy for Radiation Failure in Early Glottic Cancer

陳錚宇(Cheng-Yu Chen) ； 張學逸(Shyue-Yih Chang)

《中華民國耳鼻喉科醫學會雜誌》 31卷6期 (1996/12) Pp. 457-462

https://doi.org/10.6286/1996.31.6.457

摘要

早期喉癌治療方法的選擇，主要考慮是能否施行部分喉切除手術和重建來保留喉部發聲機能，以及病患對音聲品質的要求。由於早期喉癌放射線治療後復發往往不易早期診斷以及腫瘤本身可能的持續進展，因此除了少數病例可以做部分喉切除外，大多仍須接受全喉切除手術。自1982年2月至1995年1月，我們共有10例早期喉癌患者接受放射線治療後局部復發，而接受了垂直式部分喉切除術治療。除1例追蹤時間為1年2個月，其餘9例皆在4年以上，平均追蹤時間為97個月，追蹤期間均無復發情形，局部控制率為100%。選擇適當的病例及手術方法是獲得理想治療效果的關鍵。根據我們的經驗，對這種特殊的病患，以會厭軟骨瓣重建是目前較為可行的方法，其優點在於經放射治療的患者，不致有重建組織壞死之虞；且會厭軟骨本身可提供呼吸道支撐作用。以放射線治療早期喉癌時，除了定期追蹤之外，更因為放射治療後的復發不易早期診斷，所以臨床醫師必需保持高度的警覺性，方能使更多病患有再一次治療及保留發聲的功能。

關鍵字

垂直式部分喉切除術 ； 救助性手術 ； 早期喉癌 ； 放射線治療後復發

並列摘要

Both surgery and radiotherapy are treatment options for early glottic cancers. The decision making depends on individual-ized applicability of partial laryngectomy and the patient’s demand for voice quality. Usually, total laryngectomy is the treat-ment of choice for radiation failure of early glottic cancer because it is relatively difficult to detect the local recurrence and the exact tumor extent.
Ten patients with radiation failure of early glottic cancer undergoing salvage vertical partial laryngectomy were evalu-ated retrospectively. Excellent salvage results including low complication rate and high local control rate rate as well as voice preservability were achieved. Meticulous selection of the patients and adequate reconstruction of the defect were the keys to a successful rescue surgery. In view of the laryngoplasty after tumor ablation of a radiation failure case, we recommended an epiglottic flap for enhancing the wound healing and a better airway support.
Close follow-up is mandatory to an early glottic cancer patient who has received irradiation initially. Early diagno-sis of the local recurrence is important to this conservation salvage surgery.

並列關鍵字

vertical partial laryngectomy ； salvage surgery ； early glottic cancer ； radiation failure