| Objective: As one of the most familiar malignant tumors in head-neck， theincidence of laryngeal cancer is increasing in recent years. With the early diagnosis rate oflaryngeal cancer rising stage by stage, the development of partial laryngectomy hasbecome increasingly widespread with encouraging long-term survival and functionalresults. With the development of medical science, the status of quality of life of patientswith tumors in the evaluation of the effect of treatment is increasingly improved. Thisstudy aimed to explore the curative effect of partial laryngectomy in patients with laryngealcarcinoma, and intended to evaluate postoperative quality of life and influencing factors inpatients undergoing the operation with laryngeal function preservation.Methods: Clinical data of124cases of laryngeal cancer treated by partiallaryngectomy in our department from January2002to December2006have beenretrospectively reviewed. These patients all possessed pathologic diagnosis and completefollow-up records. The group of cases was male, with ages ranged from37to76years(mean age,58.29+9.34). The pathological diagnoses were squamous cell carcinoma.Wherein,42cases were supraglottic carcinomas,82cases were glottic carcinomas, nosubglottic and transglottic carcinomas. Classified accordingly by UICC standard of years2002:24cases of T1N0M0,52cases of T2N0M0,8cases of T2N1M0,22cases of T3N0M0,11cases of T3N1M0,7cases of T3N2M0;24cases of stageⅠ,52cases of stage II,41cases ofstage III,7cases of stage ⅣA. In common6kinds of operations were performed:17casesunderwent horizontal supraglottic laryngectomy,25SCPL-CHP,13cordectomy,32vertical laryngectomy,19extended vertical partial laryngectomy,18SCPL-CHEP.62casesunderwent concurrent neck dissection. All patients with stage T3and the patients withcervical lymph node metastasis and positive margins in stage T2(48cases) accepted neckradiotherapy with conventional segmentation within4to6weeks after operation. Thecurative effect of partial laryngectomy was determined by the statistics of3,5years survival rate and recovery of laryngeal function. Using the International General WashingtonCollege Students Quality (UW-QOL) scale, we studied88patients’ quality of life excludethe patients of death, distant metastasis, miss and obvious cardiopulmonary dysfunctionand other chronic disease, and analyzed its influencing factors.Results: All cases restored their phonation without difficulties in social interactionsand overcome aspiration with removing nasal feeding from4to45days after operations.115cases were decannulated after operations. Decannulation rate was92.74%. Theaverage time of decannulation was11(5-120) days. The complications occurred in9casesin our group, included5wound infection,2pharyngeal fistulas after operation,1lymphleakage, and1postoperative severity aspiration pneumonia due to inhalation. Thesecomplications were cured by conservative treatment. All cases were followed up for5years; the follow-up rate is91.1%, dollars lost to death. The3-year survival rates were83.1%（103124）.The5-year survival rates were72.6%（90124）.26died,12cases died oflocal recurrence,9died of cervical lymph node metastasis,3died of lung metastasis and2died of cerebral accident. The UW-QOL was used to analyze and assess the postoperativequality of life of the screening of88patients, the mean score for692.34+127.94. Stepwisemultiple regression analysis of radiotherapy and stage of the disease were the maininfluential factors of quality of life. The patients pay more attention to living requirementincluding communication, activities, recreation, work, swallowing, chewing, appearance,pain and shoulder function.Conclusion: Correct operation mode with laryngeal function preservation on thebasis of the position, extent and clinical staging of laryngeal carcinoma not only canachieve a higher survival rate of patients, but also efficiently keep the basic function oflarynx. The postoperative qualities of life in patients with partial laryngectomy achieve ahigh level and reach an almost normal bio-psycho-social integration. Radiotherapy andstage of the disease are the main influential factors of quality of life. |
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