| Objective: Along with our country national increased life expectancy, gradually increased in senile patients with laryngeal carcinoma, laryngeal cancer therapy based on operation, and many ways of operation. Modern laryngeal carcinoma operation treatment principle is on the basis of thorough resection of tumor, as much as possible to protect the laryngeal function, improve the life quality of the patients. Senile laryngeal cancer patients because of physical weakness, poor lung function, partial laryngectomy may occur after serious complications such as aspiration, but lost the pronunciation function after total laryngectomy and need of permanent tracheal fistula is a lower quality of life. Supracricoid partial laryngectomy(SCPL) operation in recent years is widely used in the preservation of laryngeal function, more complete excision of the tumor at the same time, to be able to speak well preservation of laryngeal breathing, and swallowing three big functions, including a ring-shaped cartilage hyoid bone fixation(CHP) and the cricoid cartilage- hyoid- epiglottic fixation surgery(CHEP) in two kinds of basic operation mode. The purpose of this study to investigate the excision of part of supracricoid(CHEP, CHP) for the treatment of senile patients with laryngeal carcinoma treatment effects, possible complications and clinical characteristics, to provide clinical experience for treatment of senile laryngeal cancer operation. Method: in 2004-2012 years head and neck surgery underwent supracricoid partial laryngectomy in laryngeal carcinoma of aged more than 60 years, and the clinical data of 21 patients with follow-up data were analyzed in detail, through standardized swallowing assessment scale(SSA) on postoperative patients with dysphagia function was evaluated, and the patients were observed after tracheotomy tube drawing, follow-up analysis of postoperative survival rate of 3 year and 5 year survival rate. Results: 21 cases of senile patients with laryngeal carcinoma in male 19 cases, female 2 cases, for a maximum of 79 years old, had the history of smoking. Glottic type in 17 cases, which one case of recurrence,T1bN0M0 1 cases,T2N0M0 10 cases, T3N0M0 4 cases, T3N1M0 1case; 4 cases of supraglottic type,which T3N0M0 2 cases, T2N0M0 2 cases. The line ring- hyoid- epiglottic fixation(CHEP) in 14 cases, ring- hyoid bone fixation(CHP) in 7 cases, underwent neck dissection in 9 cases were squamous cell carcinoma, pathology. 21 patients without postoperative death and severe complications of peri operation period, after tenth to 20 days(mean 15 days) removal of nasal feeding tube, the recovery of swallowing function self feeding. 21 cases of postoperative elderly patients 20 cases successively to trachea cannulas were removed, the decannulation rate was 95.2%; 17 cases were followed for 3 years in one case died of a cerebral hemorrhage, the 3 year survival rate was94.1%(16/17); 12 cases were followed up for over 5 years in 1 cases of death, death cases of partial re issued a total laryngectomy after 1 years, 5 years survival rate was 83.3%(10/12). Conclusion: Supracricoid partial laryngectomy in laryngeal carcinoma radical resection of tumor in elderly base on some basic structure through the larynx preservation,preservation of the basic physiological function of larynx.The postoperative recovery of swallowing function independent oral feeding, reserving vocal and ventilation function of avoiding permanent tracheal fistula, quality of life improve significantly after surgery. After strictly grasp the indications for surgery under the premise of supracricoid partial laryngectomy to senile patients with laryngeal carcinoma provides a safe, convenient and reliable operation. |
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