目的 探讨在喉癌外科治疗前先行气管切开对喉癌患者预后的影响.方法 2006年10月～2008年10月收治的喉鳞癌患者共173例,其中因呼吸困难需先行气管切开,再行喉切除手术者82例(A组),同期临床特征相似的喉癌患者91例(B组),分别比较2组病例的局部控制率、颈部控制率以及5年总生存率.结果 A组82例,均先行气管切开,喉部新生物活检,1周左右待病理确诊为喉鳞癌后再行喉切除术,术后局部复发30例、颈部淋巴结转移20例、全身转移7例;B组91例,同时行喉切除术和气管切开或单独行喉切除术,术后局部复发14例、颈部淋巴结转移9例、全身转移3例.2组局部复发率(36.3％∶15.4％)差异具有统计学意义(x2=10.222 6,P＜0.005),颈部淋巴结转移率(24.4％∶9.9％)差异有统计学意义(x2=6.499 5,P＜0.05),5年总生存率(54.9％∶72.5％)差异有统计学意义(x2=7.778,P＜0.05).结论 在喉癌外科治疗前行气管切开术可被认为是影响喉癌预后的独立阴性因素.%Objective To investigate the impact of preoperative tracheotomy (POT) on the prognosis of patients with laryngeal cancer.Methods A total of 173 patients with laryngeal squamous cell carcinoma were chosen from October 2006 to October 2008,which were divided into two groups.Group A had 82 cases undergoing POT for laryngeal obstruction,followed by further laryngectomy.Group B had 91 cases.The local control rates,neck control rates and survival rates of five years were compared between the two groups.Results Patients in group A were firstly performed tracheotomy,followed by laryngeal neoplasm biopsy,then laryngectomy were performed until pathology was identified.The five-year overall survival (OS) and local recurrence,lymph node metastasis of patients undergoing POT versus no POT were 54.9％ vs.72.5 ％ (P ＜ O.05),36.3％ vs.15.4％ (P ＜ 0.05) and 24.4％ vs.9.9％ (P ＜0.05),respectively.Conclusions POT may be considered as an independent negative prognostic factor in laryngeal cancer.
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