聲門上部份喉切除術之長期經驗

Long-term Experience of Supraglottic Laryngectomy

朱本元(Pen-Yuan Chu) ； 張學逸(Shyue-Yih Chang)

《中華民國耳鼻喉科醫學會雜誌》 33卷5期 (1998/10) Pp. 486-493

https://doi.org/10.6286/1998.33.5.486

摘要

背景：喉癌是國人常見的頭頸部癌症之一，其發生率僅次於口腔癌、鼻咽癌，而位居第三位。在我們過去的研究發現，喉癌中以聲門癌最多聲門上癌居次，聲門下癌最少。聲上癌因早期症狀不明顯，所以不易早期珍斷，但若能早期發現，則往往仍能施行部份喉切除手術，保留住喉部機能。
方法：回溯性的分析自1981年至1996年在本科接受聲門上部份喉切除術的聲門上癌27例病患，其術後的併發症，機能的恢復，及腫瘤控制的情形。
結果：27例病患，均為男性，平均年齡為62歲。在腫瘤的分期方面：T1有2例，T2有18例，T3有1例，T4有6例；有9例合併頸部淋巴轉移，其中有2例為兩側頸部淋巴轉移。除原發部位的手術外，有20例同施行頸部淋巴廓清術，其中單側13例，雙側7例。僅1例在術後接受放射線治療。術後有2例發生較嚴重的併發症，包括1例因氣切口附近發炎，造成無名動脈（innominateartery）破裂而死；1例因對術後氣切管滑脫，而造成成腦部缺氧性壞死。術後初期病患大多有暫時性吞嚥誤嗆的現象，但經吞嚥訓練後，均可拔除鼻骨管，由口進食；有3例曾發生吸入性肺炎，僅1例因反覆性的吸入性肺炎，而須施行全喉切除術。手術後平均追蹤期間為三年半，3年無病存活率（disease-free survival rate）為88.7%，病患中並無局部復發的病例，僅1例產生頸部復發，2例產生遠端轉移，2例發生第二原發惡性腫瘤（secdodary primary malignancy）。
結論：聲門上部份喉切除術對於早期的聲門上癌，都可達到徹底清除腫瘤的目的，並能保留喉部的重要機能。由於容易產生頸部淋巴的轉移，故手術時須同時施行頸部淋巴廓清術。

關鍵字

聲門上部份喉切除術 ； 聲門上癌 ； 喉

並列摘要

Background: Laryngeal cancer is the third commonest of head and neck cancer in Taiwan other than the oral cavity cancer and nasopharyngeal cancer. In our previous study, supraglottic region was the second common site for laryngeal cancer. Diagnosis of the early tumors originating from this area are difficult because of lack of symptoms in the early stage. However, if it can be diagnosed early, supraglottic laryngectomy is adequate for tumor clearance and laryngeal functional preservation.
Methods: We retrospectively reviewed supraglottic cancer patients who had received supraglottic laryngectomy in our department from 1981 to 1996. Postoperative complications, laryngeal functional recovery, and tumor control rate are analyzed.
Result: Twety-seven patients received supraglottic larynegectomy in this study. All of them were male. The mean age was 62 years. The tumor stage included 2 to T1 cases, 18 T2 cases, 1 T3 case and 6 T4 cases. There were 9 cases with neck metastases, 7 cases had ipsilateral neck metastasis and 2 cases had bilateral neck metastases. In addition to supraglottic laryngectomy. 20 cases received neck dissection. Thirteen ipsilateral neck dissection and 7 bilateral neck dissection were performed. One patient received postoperative radiation therapy. There were 2 serious postoperative complications, included 1 death due to tracheostomy infection resulted in innominate artery ruture, and 1 hypoxic encephalopathy because of dislocation of tracheostomy tube. In the postoperative course, 3 patients had aspiration pneumonia. All except one patient was able to remove the nasopharyngeal tube smoothly after swallowing training. Only 1 patient eventually received total laryngectomy due to persistent aspiration pneumonia. In the follow-up period of mean 3.5 years, there were no local recurrence, but 1neck recurrence, 2 distant metastases and 2 secondary primary malignancies were noted. The 3-year disease-free survival rate was 88.7%.
Conclusions: Supraglottic laryngectomy is an effective method to remove the primary tumor and preserve the laryngeal function for early stage supraglottic cancer. Bacause of the high incidence of neck metastases, neck dissection is often necessary for these patients.

並列關鍵字

supraglottic larygnectomy ； supraglottic cancer ； larynx