中国喉癌外科治疗现状

1、Curre nt Status of Lary ngeal Carci noma Thera py in Chi naProf. Han DeminBeiji n Tongren Hos pitalThe in cide nee of lary ngeal carc inoma in North China is higher tha n that in South. Itsaverage incidenee is about 3.3 per 100,000, covering 1%-2% of all cancers and11%-22% of head and n eck tumors.

2、Surgical treatme nt is selected as the usual methodof laryngeal carcinoma in several decades.Total laryngectomy was predominant inthe p ast while p artial lary ngectomy has rece ntly in creased which covers 49% to 56%of all such p atie nts. The 5-year survival rate has arrived at 70% to 80%. (See Ta

3、ble 1)Locatio nAuthorP artial/Total Lary ngectomySurvival Rate of Total Lary ngectomySurvival Rate of P artial LarygectomyHarbi nJia Shen sha n(1988)41/161 (26%)77%77%（3年）ShenyangGuo Zhixia ng(1988)38/168 (23%)52%90%（3年）Shan ghaiHua ng Weit ing (1990)11/111 (10%)36%73%（5年）GuangzhouZeng Zon gyua n(19

4、90)5/227(2%)40%65%（5年）Beiji ngTu Guiyi(1992)317/653 (49%)73%71%（5年）ShenyangFei She ngzho ng(1993)242/622 (39%)66%78%（5年）JinanDong Pin(1993)130/199 (65%)47%Taiyua nLi Ga ngzho ng (1993)168/260 (65%)82%68%（5年）Beiji ngHan Demin(1997)186/314 (59%)65%73%（5年）(1) . P artial Lary ngectomy1) . Small P artial

5、 Lary ngectomy1. Cordectomy: Cordectomy is applicable for small lesions confined to themembra nous p orti on of a mobile vocal cord, not sp read ing to the an terior commissureand the vocal p rocess of aryte no id. The 5-year survival rate is above 90% for T1lesi ons by lary ngofissure or en dosc op

6、ic laser surgery.2. Hemilaryngectomy: Hemilaryngectomy is applicable for the lesions of themembra nous p orti on of ip silateral vocal cord which have app roached or invo Ived thean terior commissure without vocal cord imp aired. The resect ion in cludes theanteriorly one third of contralateral thyr

7、oid cartilage.3. Frontal Laryngectomy: Frontal laryngectomy is applicable for the anteriorcommissure carcinomas or the lesions involving the anterior of bilateral vocal cord.The excision includes the anteriorly one third of bilateral thyroid cartilage and thebilateral vocal cord.4. Epiglottogectomy:

8、 Epiglottogectomy is applicable for the early epiglottiscarcinoma. The excision includes epiglottis and preepiglottic space. The mainfunctions of larynx including deglutition, breathing and speech may recover afteroperation. The rate of tubing is 95% and 5-year survival rate 90%.2) . Large Partial L

9、aryngectomy1. Vertical Laryngectomy: Vertical laryngectomy is applicable for glottis lesionswhich involves ispilateral vocal cord, spreading no less than 10mm inferiorly from theanterior of vocal cord. The mobility of vocal cord is impaired. The 5-year survivalrate is about 87.5%.2. Supraglottic Lar

10、yngectomy: Supraglottic laryngectomy is applicable for thelesions that involve the epiglottis, the false vocal cord and/or aryepiglottic fold. Thelarygneal functions may recover after operation. The 5-year survival rate is 82.3%.3) . Subtotal Laryngectomy1. Extended Vertical Laryngectomy: Extended v

11、ertical laryngectomy is applicablefor the glottic lesions involving the ipsilateral vocal cord, anterior commissure andcontralateral vocal cord anteriorly which speads inferiorly no less than 15mmanteriorly and 34mm posteriorly. The mobility of vocal cord is impaired. The 5-yearsurvival rate is abou

12、t 73%.2. Horizontal Vertical Laryngectomy: Horizontal vertical laryngectomy, orthree-quarter laryngectomy, is applicable for the supraglottic lesion which involvesthe ispilateral ventricle, the false and true vocal cord or the transglottic carcinoma.Much attention should be paid to the old and the f

13、eeble with the invasion of the baseof tongue.3. Eipglottic-trachealopexy and Cricoid-pharynopexy: These operations areapplicable for the patients who can not undergo any other partial laryngectomy. Onlyepiglottis or cricoid cartilage, the other portions of the whole larynx will be applied.4. Near-to

14、tal Laryngectomy: This procedure preservesa narrow myomucosal strip of larynx or hypopharynx, which connects the trachea and pharynx. Thus, a dynamic shunt is maintained for prosthesis-free speech.(2) . Minimally Invasive Laryngeal SurgeryCO2 laser laryngeal surgery has developed in China since 1990

15、s. 5-years cure rates thereof is 90%, with no difference with that of patients treated by laryngofissure of radiotherapy.1). Applications of Laser Surgery1. Applications is not required. The period of hospitalization is shorter and the costs is lower.A、Glottic carcinoma T1-T2B、Suprahyoid epiglottic

16、carcinoma T1-T2C、Limited aryepiglottic folds carcinomaD、False vocal cord carcinoma2. Relative ApplicationsThere is conflict about these lesions treated by laser surgery.A、1. T1 Glottic lesions involve the anterior commissure or anterior commissurecarcinoma.B、2. T1 Glottic lesions involve the vocal p

17、rocess or the arytenoids.C、3. T2T3 Glottic lesions rely on the exposed degree under the suspensionlaryngoscopy.D、4. Supraglottic carcinoma T2-T32). Estimation of Curative EffectsHan Demin, Huang Zhigang and others reported 217 cases of glottic carcinomatreated by CO2 laser surgery in 2002. There wer

18、e 21 cases of recurrence afteroperation at the recurrence rate 9.7% (21/217). The 3-year survival rate was 97.2%(211/217). The 5-year survival rate was 89.4% (118/132).The trachectomy rate of laser surgery is very low. Meanwhile, the nasalgastric tube73). Complication of CO2 Laser SurgeryIt includes

19、 bleeding, subcutaneousemphysema, burning upper lip, teeth flexible or falling, and endotrachea tube burning et al. Huang et al. reported 17cases had various degrees of complications. The occurrence rate was 7.8% (17/218).(3) . Treatment of Neck Lymph NodePatients with clinically positive neck disea

20、se may be treated by functional or radical neck dissection. However, for the patients without significant lymph node clinically, there are conflicts about treatment of neck lymph node. The estimated preoperation measurements should include palpation, B ultrasonic, CT and MRI et al. The treatment of

21、clinically neck disease includes: 1. Follow-up: Preventive neck dissection is not advised.2. Radiotherapy: Postoperative radiotherapy would reduce the recurrence rate.3. Surgical Operation: For supraglottic cancer with highly neck metastases, elective neck dissection (level II and III) is removed an

22、d sent for pathological examination.Neck dissection will be necessary if pathological positive and follow-up for pathological negative.(4) . Voice Rehabilitation after Total Laryngectomy1). Operating Methods : functional voice rehabilitation of treacheal-esophageal fistula, such as Blom-Singer et al

23、.2). Non-operating Methods : esophageal speech, electrical larynx et al. Two seminars of voice rehabilitation were held in China last year.Brief Introduction to Chinese Otorhinolaryngological SocietyYang Wei-YanPLA General Hospital ENTThere was no otorhinolaryngology in China until 1906, when the “

24、Department of Eye, Ear, Nose and Throat ” was established in the Beijing Union Medical College of the time. Dunlopam was the first otorhinolaryngologist in China, followed by Liu Ruihua (1916) and Gao Shien (1918). After that, the number of Chinese otorhinolaryngologist increased rapidly. By 1949, m

25、ore otorhinolaryngological departments were set up in hospitals in Shanghai, Beijing, Nanjing, Guangzhou, Qingdao, Tianjing and so on, having specialists not more than 100.Since the founding of the People's Republic of Chin,agirne1a9t 4d9evelopmentin health service has been achieved and a large

26、number of otorhinolaryngological clinicians been trained in Beijing, Shanghai, Nanjing etc.Founded in 1951, one year after the establishment of China Medical Association (CMA), Chinese Otorhinolaryngological Society is a secondary clinical institution of the CMA, consisting of subjects on otology, r

27、hinology, laryngology, head-and-neck surgery and esophagus. Each subject is divided into a variety of groups. And academic authorities of these subjects and groups constitute a nationwide academic net.Up to the present, the number of otorhinolaryngological clinicians in all levels of hospitals in Ch

28、ina has topped 20,000, more than half of which are members of Chinese Otorhinolaryngological Society.All domestic large hospitals have special otorhinolaryngological outpatient departmentsand wards (with ward beds more than 3,000), and some of them even have tertiary specialties such as otology, rhi

29、nology, laryngology and head-and-neck surgery.The clinical service range of otorhinolaryngology has been beyond the traditional fields of ear, nose, throat, trachea and esophagus, widely involving tissues and structures nearby, top to the cranial base and bottom to the mediastinum. Therefore, in pra

30、ctice, ear-nose-throat-head-neck surgery has already come into being. Otomicrosurgery, otoneurosurgery, cranial base and head-and-neck surgery, minimally invasive surgery basedon endoscopy and orientation, plastic reconstruction surgery related to head, neck and face defects, phoniatrics, hearing sp

31、eech disorder rehabilitation and vertigo treatment have become routine work.Presently, there are 8 medical colleges offering 5-year undergraduate Otorhinolaryngology Programs (or called Eye, Ear, Nose and Throat Program) and graduate degrees in otorhinolaryngology can be conferred in all provinces a

32、nd localities. There are 15 doctorial programs, 3 national key subjects and 13 research institutes on otorhinolaryngology in the country. These institutes are focusing on the following directions: (1) diseases related to nasal sinus, nose and eye, nasal neurosurgery, (2) anatomy and physiological fu

33、nctions of throat, Obstructive Sleep Apnea Syndrome, (3) histopathology of ear, physiology of hearing and balance, pathogenesis,prevention and treatment of deafness, (4) pathogenesis and complex treatment (surgery, radiation, chemical and biology) of head-and-neck tumor, (5) replacement therapy for

34、Sensorineural Hearing Loss and hearing speech disorder rehabilitation. Currently, the study, by molecular biology methods, in research of genes for the diagnosis and biological treatment of deafness and head-and-neck tumors has aroused intense interest of researchers.There are 10 pertinent periodica

35、ls: Chinese Journal of Otorhinolaryngology (authorized by CMA), Journal of Clinical Otorhinolaryngology , Chinese Archives of Otolaryngology-Head and Neck Surgery, Chinese Journal of Otorhinolaryngology-Skull Base Surgery, Audiology and SpeechDisorder, Chinese Journal of Otology, China Journal of Eye Ear Nose and Throat, Journal of Otorhinolaryngology , Chinese Journal of