ABSTRACT
Objective@#To discuss the strategy of therapeutic management of T3 supraglottic carcinoma.@*Methods@#A retrospective analysis of 459 patients with T3 supraglottic carcinoma treated in our hospital was performed. We evaluated the results of different managements, including surgery alone, preoperative radiotherapy, postoperative radiotherapy and radiotherapy alone. The extent of the lesion was also put into analysis. Statistical analysis of the overall survival (OS), cause-specific survival (CSS), local control (LC), regional control(RC), function-conservation (FC) were performed with the statistical package from SPSS.@*Results@#In all patients, the rates of 5-year OS, CSS, LC, RC and FC were 64.2%, 71.2%, 87.8%, 78.8% and 64.5% respectively. The OS, LC and FC of the patients treated by surgery alone, preoperative radiotherapy and postoperative radiotherapy had no significant difference, and were remarkably better than that of patients treated by radiotherapy alone (P<0.001). In 412 patients treated by surgery, 300 patients received function-conservation laryngectomy. 209 patients (50.7%, 209/412) survived and maintained well-function of larynx for 5 years, which was significantly better than those in the radiotherapy alone group (27.7%, 13/47). The patients with the lesion invading the pre-epiglottic space but limited in supraglottic area had better OS (70.2%), LC (93.5%) and FC (85.1%). The rate of 5-year neck lymphatic metastasis was 56.2%(258/459), and the 5-year OS of patients with N0, N1, N2 and N3 stage were 76.0%, 66.2%, 50.5% and 13.0% respectively.@*Conclusions@#Surgical treatment was the best therapeutic approach for T3 supraglottic laryngeal carcinoma. Most patients with T3 lesions are suitable for function-conservation laryngectomy. Surgical procedure was determined by tumor invaded location and extension. The combined therapy of surgery and radiotherapy had no significant advantage.
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Objective:To compare the effects of different anesthesia methods on stress hormones and hemodynamic changes in the patients with gynecological laparoscopic surgery. Methods:Retrospective analysis was carried out. Totally 145 patients with gynecolog-ical laparoscopic surgery were divided into two groups according to the anesthesia method, the control group with 72 cases was given routine remifentanyl propofol intravenous anesthesia, and the observation group with 73 cases was given routine propofol isoflurane com-posite anesthesia. Such hemodynamic indices as SBP, DBP and HR, and plasma NE, E, cort and AT II levels at different time points in the two groups were studied and compared, and adverse drug reactions were also observed in the two groups. Results:The BP and HR at T2 and T3 time point in the two groups were significantly lower than those at T0 time point (P<0. 05), and those in the obser-vation group were lower than those in the control group at the same time point(P<0. 05). The levels of NE, E, cort and ATⅡat T2 and T3 time point in the two groups were significantly higher than those at T0 time point (P<0. 05), while the increase in the observa-tion group was lower than that in the control group (P<0. 05). The incidence of adverse drug reactions (ADR), such as respiratory depression, hypertension, bradycardia and so on, and the total incidence of ADR in the observation group were both lower than those in the control group (P<0. 05). Conclusion:Compared with remifentanyl propofol intravenous anesthesia, propofol isoflurane composite anesthesia can keep the hemodynamic stability more effectively and reduce the stress reaction with fewer ADR and promising safety, which is worthy of wider application in clinics.
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Objective To investigate the necessity of primary neurorrhaphy (direct end-to-end anastomosis) when the recurrent laryngeal nerve(RLN) is severed during thyroid surgery.Methods 15 patients who suffered from iaotmgenic unilateral complete RLN injury or whose unilateral RLN had to be sacrificed because of disease invasion had a primary repair of RLN by direct end-to-end anastomosis.In control group,26 patients who did not have a nerve repair were enrolled into this study.Subjective evaluation of aspiration and voice quality were based on patient reports and hearer reports for all patients.9 patients with neurorrhaphy and 12 patients without nerve repair were followed with videolaryngoscopic examination.Results 14 patients undergoing neurorrhaphy restored normal voice at 2-5 months postoperatively.Although there were no significant functional motion of the vocal fold,slight adductory movement of the affected arytenoid was found with good tension vocal cords and symmetric arytenoids of the glottis during phonation.Only 2 patients without nerve repair had nearly restored normal voice.The patients with hoarseness had stiff arytenoids and atrophic folds resulting in glottal gap.Conclusions Neurorrhaphy is a simple and effective method to restore the normal aspiration and voice quality of patients with unilateral complete recurrent laryngeal nerve injuries.