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Learning Modern Laryngeal Surgery in a Dissection Laboratory
Published on: March 18, 2020
[The long term results of partial laryngectomy]
Hongzhi Ji1, Huixue Zhuang, Ping Zhu
1Department of Otolaryngology, Jinan Military General Hospital, Jinan 250031.
Objective:
To evaluate the long-term results of various kinds of partial laryngectomy.
Method:
The following-up materials from 264 patients who had undergone partial laryngectomy in this department from 3,1984 to 3,1998 wert analyzed. The pathological diagnosis of all the cases was squamous cell carcinoma. The surgical technique were divided into eight kinds: 1. laser vocal cord ectomy for 19 cases, 2. vocal cordectomy through laryngofissure for 29, 3. laterovertical partial laryngectomy for 58, 4. frontovertical partial laryngectomy for 18, 5. suproglottic partial laryngectomy for 42, 6.vertical-horizontal partial laryngectomy for 29, 7. extended subtotal laryngectomy for 51(extended to the base of tongue 23, to pyriform recess 25, to trachea 3), 8. subtotal laryngectomy for 18 (including 3 cases of middle segment partial laryngectomy and hypopharynx-trachea anastomasis). One hundred thirteen cases (146 sides) received neck dissection simuteniously. The materials that were used to reconstruct the operative defect simply or in combination included cervical myocuteneous flap, cervical myofascia flap, false cord, local laryngeal mucosa, thyroid perchondrium and epiglottis.
Result:
All the patients restored the function of phonation. No aspiration happened in 89 cases,mild aspiration in 112,moderate in 57 and severe in 6 cases. But the aspiration disappeared after a certain time of practice and the swallowing function restored in all patients. The rate of decannulation was 82.95%. The survival rate of 3-year,5-year and 10-year was 86.74% ,78.47% and 53.33%, respectively. The main causes of death were local recurrence and lymphatic metastasis, and 71.4 percent of the death happened in the first 3 years.
Conclusion:
The partial laryngectomy was a racial surgery as the same as total laryngectomy. The key point to success was to apply the operative indication strictly. And the important landmark of the patients' survival quality was the decannulation rate and the restoration of laryngeal functions. Correct management on cervical lymphatic nodes could raise the 3-year and 5-year survival rate.
