本文選題：聲門型喉癌　切入點：環(huán)狀軟骨上喉部分切除術(shù)　出處：《吉林大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:對比分析喉微創(chuàng)術(shù)和環(huán)狀軟骨上部分切除術(shù)對于符合適應癥的部分早期聲門型喉癌的療效及其他預后差異,為此類患者的治療提供依據(jù)。方法:搜集我院自2007年1月-2011年12月5年間收治、病理診斷明確(術(shù)前病理或術(shù)中快速病理),并于我科行喉微創(chuàng)手術(shù)或環(huán)狀軟骨上喉部分切除術(shù)的早期聲門型喉癌患者47例(其中行喉微創(chuàng)術(shù)患者24例記為A組,環(huán)狀軟骨上喉部分切除術(shù)患者23例記為B組),查閱病歷并進行隨訪(電話隨訪或門診復診時隨訪)。先對2組整體的術(shù)后轉(zhuǎn)歸的幾個獨立因素用卡方檢驗、非參數(shù)秩和檢驗進行單變量分析。再對不同手術(shù)方式對2組患者的住院時間、手術(shù)時間、住院費用等的影響進行對比分析,根據(jù)結(jié)果評估2種術(shù)式的臨床療效。P0.05具有統(tǒng)計學意義。結(jié)果:A組24例失訪2例,B組23例失訪2例,均不列入統(tǒng)計分析數(shù)據(jù)。獲得隨訪的43例患者,A組術(shù)后隨訪時間月37個月-119個月,平均隨訪時間90.2個月,B組隨訪時間跨度范圍27個月到116個月,平均為79.8個月。A組術(shù)后5年生存率90.9%,B組為90.5%。對于本文調(diào)查的T1b N0M0期聲門型喉癌,未發(fā)現(xiàn)有統(tǒng)計學意義,影響患者預后的單變量,但調(diào)查顯示術(shù)后復發(fā)的患者術(shù)后生存時間較未復者明顯縮短,且本文資料均為5年內(nèi)復發(fā),復發(fā)者中死亡率80%(5例復發(fā),4例死亡),4例均于術(shù)后5年內(nèi)死亡,結(jié)果都為局部病灶或淋巴結(jié)復發(fā)。2組患者的住院時間、住院期間費用采用非參數(shù)檢驗、手術(shù)時間用t檢驗的對比,發(fā)現(xiàn)喉顯微即微創(chuàng)手術(shù)比開放性喉環(huán)狀軟骨上部分切除手術(shù)可以較大程度的減少住院、手術(shù)時間和住院費用,P0.05,具有統(tǒng)計學意義。結(jié)論:喉微創(chuàng)手術(shù)和環(huán)狀軟骨上喉部分切除術(shù)均在較好的腫瘤治療效果的基礎(chǔ)上最大限度地保留了喉的呼吸、發(fā)音、吞咽等生理功能,使患者術(shù)后維持較好的生活和心理狀態(tài)。作為最近幾年發(fā)展迅速的一種術(shù)式,喉微創(chuàng)術(shù)相比喉環(huán)狀軟骨上部分切除術(shù)有相似的腫瘤治療效果,但無需氣管切開、頸部無切口,手術(shù)時間短,術(shù)后正常進食,住院時間明顯縮短、住院費用相對較低;術(shù)后均無誤吸,恢復快,具有更加優(yōu)越的療效,在嚴格掌握適應癥的情況下,值得臨床推廣。
[Abstract]:Objective: to compare and analyze the curative effect and other prognostic differences of laryngeal minimally invasive laryngectomy and annular suprachondral partial resection for partial early glottic laryngeal carcinoma in accordance with the indication. Methods: from January 2007 to December 5th 2011, the patients were collected and treated in our hospital. 47 patients with early glottic laryngeal carcinoma underwent laryngeal minimally invasive laryngectomy or partial laryngectomy with annular suprachondral laryngectomy (including 24 patients with laryngeal minimally invasive laryngectomy as group A). Twenty-three patients with partial ring-chondroid laryngectomy were recorded as group B, and their medical records were consulted and followed up (telephone follow-up or out-patient follow-up). Chi-square test was used to test several independent factors of the overall postoperative outcome in both groups. The non-parametric rank sum test was used for univariate analysis. The effects of different surgical methods on the hospitalization time, operation time and hospitalization cost of the two groups were compared and analyzed. Results there were 24 cases of missing visit in group A, 2 cases in group B, 2 cases in group B, 2 cases in group B, 2 cases in group B, 2 cases in group B, 2 cases in group B, 2 cases in group B, and 2 cases in group B. 43 patients in group A were followed up from 37 months to 119 months, and the mean follow-up time was 90.2 months. The follow-up time of group B ranged from 27 months to 116 months. The average 5-year survival rate of group A was 79.8 months. The 5-year survival rate of group B was 90.5. There was no significant single variable for stage T1b N0M0 glottic laryngeal carcinoma investigated in this paper. However, the investigation showed that the survival time of the patients with postoperative recurrence was shorter than that of the patients without recurrence, and the data in this paper were all recurrence within 5 years. The mortality rate of the patients with recurrence was 80%, 5 cases with recurrence and 4 cases with death, and 4 cases died within 5 years after operation. The results showed that the hospitalization time of the patients with local focus or lymph node recurrence in group 2, the cost of hospitalization was nonparametric test, and the operation time was compared with t test. It was found that laryngeal microsurgery, or minimally invasive laryngotomy, could reduce hospitalization to a greater extent than open partial laryngeal ring-chondroidectomy. Conclusion: minimally invasive laryngectomy and partial laryngectomy of annular suprachondral laryngectomy can preserve the physiological functions of larynx, such as breathing, pronunciation, swallowing and so on, on the basis of better therapeutic effect of tumor. As a rapidly developing procedure in recent years, laryngeal minimally invasive laryngectomy has a similar effect on tumor treatment compared with partial laryngeal annular suprachondral resection, but without tracheotomy and neck incision. The operation time is short, the postoperative normal food intake, the hospitalization time is obviously shortened, the cost of hospitalization is relatively low; all the patients are inerrant after operation, recover quickly, have more superior curative effect, under the condition of strictly grasping the indication, it is worth popularizing in clinic.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.65

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