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Objective: To study the effect of sodium phenylbutyrate when it combined with agents used in induction chemotherapy on laryngeal carcinoma cells Hep-2 in vitro., Method: MTT were used to examine the growth inhibition of Hep-2 cells treated by the combination of PB with 5-FU or CDDP in vitro., Result: When 5-FU or CDDP combined with PB respectively, there was significantly difference between every two dose groups of the two agents or every dose group and control group ( P < 0.05). When the dosage of 5-FU or CDDP was definition,there was significantly difference between every two dose groups of PB ( P < 0.05)., Conclusion: PB could enhance the cytotoxic effects of agents used in induction chemotherapy on laryngeal carcinoma cells Hep-2 in vitro, which showed the possibility in reinforcement the treatment effect and reduction the occurrence of the complication and toxic reaction of induction chemotherapy on laryngeal carcinoma.

Objective: To explore the relationship between the expression of MDM2 and p27 in hypopharyngeal carcinoma and clinicopathological parameters and their clinical significance., Method: The expression of MDM2 and p27 in 59 hypopharyngeal carcinoma were detected by S-P immunohistochemical technique., Result: The high-expression rates of MDM2 and p27 were 66.1% and 33.9%, respectively, and the low-expression rates of them were 33.9% and 66.1%, respectively. The expression of MDM2 was unrelated to p27 (P > 0.05). The lymph node metastasis in high-expression group of MDM2 was significantly higher than that in low-expression group (P < 0.01). The expression rate of p27 was significantly different among the four T groups and degree of differentiation, respectively (P < 0.05). The survival rate was significantly higher in high-expression rate group of MDM2 than that in low-expression rate group (P < 0.01), while the survival rate was significantly lower in high-expression rate group of p27 than that in low-expression rate group (P < 0.05)., Conclusion: The expression of MDM2 and p27 may be involved in carcinogenesis and progression in hypopharyngeal carcinoma. Combined detecting of MDM2 and p27 may predict its prognosis better in hypopharyngeal carcinoma.

Objective: To explore the surgery way for T1, T2 glottic carcinoma., Method: Small partial laryngectomy were performed to 112 patients with T1, T2 (T1 N0 M0, T2 N0 M0) glottic carcinoma. The surgery method, effect and treatment advantage was summarized and compared with laser therapy and radiotherapy, the dynamic follow-up of arytaenoidea cartilage movement, glottidis rimae conformation and voice change was analyzed. The preoperative and postoperative voice quality was compared with the software of Dr. speech system for windows., Result: All incisions were healed one stage in 6 or 7 days, the mean time in hospital is 9.76 days; all patients took food with mouth after 2 or 3 days, all trachea cannula was removed successfully during in hospital, the mean time with cannula is 7.32 days and the rate of removing cannula 100%. Arytaenoidea cartilago movement of 47 cases 1 week after surgery weakened and gradually improved, glottidis rimae conformation is close to be normal after 2 months. There is no significant difference of Shimmer and NNE between preoperative and postoperative 1 week (P > 0.05), but there is a significant difference between preoperative and postoperative 2 months, half a year, and also is between postoperative 1 week and 2 months, half a year (P < 0.01). All 76 cases survive during 3 years' follow-up, 35 of 36 cases in 5 years' follow-up survive (1 case died without definite cause), and there is 2 cases for recurrence., Conclusion: Small partial laryngectomy can provide large operative view, resect the tumor completely, make diet and speech recover in shorter time and improve the voice quality, so the surgery is available.

Objective: To study effective treatment of stomal recurrence., Method: Thirty-one patients with stomal recurrence underwent surgical management. Twelve of them considered to have the probability of metastasis to regional lymphnodes underwent modified radical neck dissection. Twenty-five cases(I and II type) received complete tumor excision, but for III and IV type, only 50% (3/6) of the patients gained complete tumor excision. The surgical defects were repaired by pectoralis major myocutaneous flap in all the patients., Result: In 13 cases of type I, 7 cases had followed up for 3 years, 4 cases died, while in 12 cases of type II, 8 cases had followed up for 3 years, 5 cases died. Survival remains poor for III or IV type. Most of them died within 3 years after operation. The complication rate of pharyngeal fistula and pneumatothorax was 12.9% and 9.7%, respectively., Conclusion: The overall prognosis of stomal recurrence is dismal. A proper surgical treatment in some cases will prolong the lifetime and improve their quality of life.

Objective: To explore the methods of surgery and evaluate the long-term results of preservative surgery for T3 glottic cancer., Method: Seventy-five cases with T3 glottic cancer were treated surgically from 1989 to 1999. The lesions were removed entirely, the epiglottis, bi-pedicled myoperichondral flap, platysma myocutaneous flap, sternohyoid myofascial flap, platysma myofascial flap, thyroid perichondral flap were utilized to restore the defects of larynx and reconstruct the laryngeal functions., Result: The 3- and 5-year survival rates were 83.2% and 73.6% in all cases, 82.7% had all laryngeal functions (voice, respiration and deglutition) restored and 17.3% partially restored(voice and deglutition)., Conclusion: Preservative surgery can be carried out for T3 glottic cancer with the lesions entirely removed. Choosing and following what is optimum from multiple feasible surgical methods is a prerequisite for better laryngeal functions.

Objective: To observe the appliance value of uni-pedicled sternohyoid myofascial flap in laryngeal function reconstruction after partial laryngectomy., Method: Forty patients who underwent partial laryngectomy from 1981 to 1999 were summarized(male 36 cases, female 4 cases). Among them 19 were supraglottic carcinomas (T2N0 6, T2N2 1, T3N0 2, T3N1 1, T3N2 2, T4N0 4, T4N1 1, T4N2 2), 19 cases were glottic carcinomas(T2N0 6, T3N0 11, T3N2 2), 2 cases were subglottic carcinomas(T2N0 1, T3N0 1). The choice of surgical procedure was decided on the pathologic conditions of the larynx, the laryngeal function was reconstructed using uni-pedicled sternohyoid myofascial flap., Result: Thirty-three cases were decannulated and recovered with laryngeal functions. The decannulation rate was 82.50%. All the patients rehabilitated deglutition in 10 to 20 days after surgery. None presented complication of aspiration. The 3-year survival rate was 86.58% and 5-year survival rate was 72.49%., Conclusion: The uni-pedicled sternohyoid myofascial flaps are appropriate for reconstruction of surgical defect in laryngeal carcinomas.

Objective: To investigate clinical prognosis and the one-stage methods of reconstruction for advanced thyroid carcinoma while larynx and cervical trachea involved., Method: One-stage resection and laryngotracheal reconstruction were performed in 18 advanced thyroid carcinomas. Among them, total laryngectomy were performed in 3 cases and partial laryngectomy in the other 4 larynx-involved cases. Cervical trachea involvement were found in all 18 cases. Besides 8 shave-off of tumor, area of trachea invaded by carcinoma were removed in other 10 cases. The methods applied for the tracheal reconstruction were 1 simple suture, 3 tracheal anastomosis, 2 pedicled sternocleidomastoid myoperiosteous flap, 3 insular myocutaneous pectoralis major flap and 1 cervical flap., Result: One patient died of cancer reoccurrence while in the hospitalization. Except for 3 cases with total laryngectomy, larynx preservation were done in 14 cases and tracheal cannula were pulled out in 8, blocked in 2 and kept carrying in 4 cases., Conclusion: One stage reconstruction of larynx and cervical trachea involved by advanced thyroid carcinoma is feasible and practical. Curative rate, survival time and life quality all can be improved.

Objective: To explore the surgical methods for laryngeal cancer and long-term effects of larygectomy., Methods: 625 cases of laryngeal cancer at different stages, including 182 cases of supraglottic cancer, 429 cases of glottic cancer, and 14 cases of subglottic cancer, underwent operation of different kinds from 1979 to 1999. Radiotherapy was given to those with poorly differentiated squamous carcinoma or with metastasis of cervical lymph nodes postoperatively. The effects of operation, especially that on the preservation of laryngeal function was analyzed., Results: Partial laryngectomy was performed on 521 of the 625 cases (83.4%) and 203 of the 305 cases at stages III and IV (66.6%). The decannulation rate was 84.07% in the cases undergoing partial laryngectomy. The nasal feeding tube was removed and peroral feeding was recovered in all patients. All cases undergoing partial laryngectomy succeeded in phonation. The overall 3-year survival rate was 89.63% and the overall 5-year survival rate was 77.36%. For the cases with laryngeal cancer at stages III and IV, the 3-year survival rate among those undergoing partial laryngectomy was 84.9%, not significantly different from that among those cases undergoing total laryngectomy (87.7%, P > 0.05); the 5-year survival rate was 66.6% among those undergoing partial laryngectomy and was 69.7% among those undergoing totals laryngectomy (P > 0.05)., Conclusion: The rate of partial laryngectomy is rather high in this group. It is possible to preserve the laryngeal function without compromising the remote survival rate. The prerequisite for the preservation of laryngeal function is to master and choose the proper renovation methods.

Objective: To observe the application value of epiglottis in laryngeal reconstruction after partial laryngectomy., Methods: The data of 168 patients, 25 with supraglottic carcinoma (T1N0 2, T2N0 10, T2N1 1, T2N2 1, T3N0 7, T3N2 1, T4N0 2, and T4N2 1), 140 with glottic carcinoma (T1N0 36, T1N1 1, T2N0 52, T2N1 1, T2N2 1, T3N0 40, T3N2 2, T4N0 6, and T4N2 1), and 3 with subglottic carcinoma (T3N0 1, and T4N0 2), who underwent partial laryngectomy from 1982 to 1999 were summarized. The choice of surgical procedure was decided on the pathology of the larynx. Epiglottis was used in larynx reconstruction., Results: Out of the 168 cases, 135 cases were decannulated with a decannulation rate of 80.36%, regained deglutation, recovered all laryngeal functions, and resumed normal diet. None presented complication of accidental aspiration. The 3-year and 5-year survival rates were 89.48% and 74.14% respectively., Conclusion: Epiglottis has many advantages in laryngeal reconstruction.

Objective: To assess the possible relation between the MspI polymorphism of Cytochrome P4501A1(CYP1A1) gene and the susceptibility to laryngeal cancer., Methods: The genotypes of CYP1A1 MspI site were detected using the methods of polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) in 62 cases of laryngeal squamous carcinoma and 56 healthy controls. Genetic risk of CYP1A1 genotypes was analyzed by smoking index (SI, cigarettes smoked per day x years of smoking)., Results: Three genotypes of CYP1A1 MspI were classified into the predominant homozygotes (A), heterozygotes (B) and the rare homozygotes (C). The frequency of heterozygote B (58.1%) and genotype C (14.5%) in the patients with laryngeal cancer were higher than that of the controls (39.3%, 7.1%, P < 0.05), while their odds ratios were 2.89 (95% confidence interval, CI: 1.31-6.37) and 3.97 (95% CI: 1.10-14.28), respectively. The odds ratios of genotype C was 9 (95% CI: 1.60-50.74) in the high dose cigarette smoking group, but was 4.5 (95% CI: 0.64-31.61) in the low dose cigarette smoking group., Conclusions: With the carcinogenesis and development of laryngeal cancer, the polymorphism of CYP1A1 gene and smoking exposure together may play an important role. The individuals with genotype C are at especially high risk of laryngeal cancer, which grows with increasing cigarette consumption.

Objective: To explore new methods of preservative surgery for T4 glottic cancer and to evaluate their long term results., Methods: 22 cases with T4 glottic cancer were treated surgically from 1982 to 1998. The lesions and involved cartilage and extrinsic laryngeal tissues were removed entirely, the sternohyoid myofascial flap, platysma myocutaneous flap, platysma myofascial flap, thyroid perichondral flap and hypopharyngeal mucosa flap were utilized to restore the defects of larynx, while the epiglottis or lamina of cricoid cartilage were reserved for laryngeal function restruction., Results: The 3- and 5-year survival rates were 86.4% and 75.0% in all cases. 68.2% had laryngeal functions(voice, respiration and deglutition) restored and 31.8% partially restored(voice and deglutition)., Conclusion: Despite the fact that the T4 glottic cancer usually involved with cartilage and extrinsic laryngeal tissues, preservative surgery can be carried out for the carefully selected cases with the lesions entirely removed.

Objective: To study the feasibility, surgical technique and results of laryngeal function preservation in surgical treatment for medial wall pyriform sinus cancer., Methods: From 1992 to 1999, 31 patients with medial wall pyriform sinus cancer including stage I 1, II 4, III 14 and IV 12 lesions were treated. Partial resection of pyriform sinus and partial laryngectomy were performed, then, the remains of epiglottis and uni-pedicled sternohyoid myofascial flap were used to restore the defects of larynx. At last, the remaining hypopharyngeal mucosa was sutured to cover the wound of hypopharynx and for artificial rebuild-up. All patients received postoperative radiotherapy., Results: The 3- and 5-year survival rates were 62.1% and 43.6% respectively, with 77.4% patients having laryngeal functions (voice, respiration and deglutition) completely restored and 32.6% partially restored (voice and deglutition)., Conclusion: Conservative surgery so introduced is feasible for selected medial wall pyriform sinus cancer patients with the lesion completely resected.

Objective: To review the experience of different surgical procedures and corresponding one-stage construction methods for cervical esophageal carcinoma., Methods: 1. Thirty-three patients with cervical esophageal carcinoma were retrospectively reviewed, including 31 males and 2 females. According to UICC 1997 criteria and pathologic findings showing squamous cell carcinomas, there were 2 patients in T1N0, 4 in T2N0, 1 in T2N1, 6 in T3N0, 6 in T3N1, 7 in T4N0 and 7 in T4N1 categoris. 2. Removal of cervical esophagus was conducted in 13 patients. The type of cervical esophageal reconstruction included direct suturing, pectoralis major musculo-cutaneous flap or combined with the split graft, laryngotracheal flap and colon interposition. Total esophagectomy without thoracotomy was carried out in 20 patients. Reconstruction of the esophagus consisted of 17 stomach pulling-up and 3 colon interposition. Twenty-four patients received radiotherapy postoperatively(dose 50-70 Gy)., Results: The resectability of cervical esophageal carcinoma was 100%. The overall follow-up was from 4 months to 10 years. Two and one patient in T1, 2 survived 3 and 5 years, respectively. Three and five-year survival rates for T3, 4 were 7/16 and 3/8, respectively. Twenty-six patients had laryngeal function preserved and acquired good speech. The decannulation rate was 80% (20/25). The incidence of complication was 33.3%, including pharyngeal fistulas in 6 cases, cervical stomal fistulas in 2, cervical stomal stenosis in 2 and splitting of abdominal wall in 2., Conclusion: Surgical resection of cervical esophageal carcinoma and resolvation of the extraesophageal invasion is possible. The continuity of the esophagus is restored by pectoralis major muculocutaneous flap, laryngotracheal flap, stomach transposition and colon interposition. Combined with radiotherapy, the resectability and survival rate of the cervical esophageal carcinoma can be improved.

Objective: To improve the curative effects of laryngotracheal stenosis., Method: Seventy patients treated for laryngotracheal stenosis on the different pathologic condition of the larynx and trachea were retrospectively reviewed. Different operative reconstruction methods were used accordingly., Result: Among 70 patients, 65 (92.9) patients succeed in decannulation. The average course of usage of stent was 14.8 days, the average course from operation to decannulation was 82.0 days., Conclusion: The choice of surgical procedure must be decided on the pathologic conditions of the larynx and trachea. Eliminating the defect of the mucosa and reconstructing a wide enough airway was the key to improve the curative effect.

Objective: To investigate the relationship between polymorphism of N-acetyltransferase (NAT2) gene and genetic susceptibility to laryngeal carcinoma., Methods: A case-control study on 62 laryngeal carcinoma patients and 56 controls was conducted. NAT2 alleles were differentiated by polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP) methods using originally created PCR primers and genomic DNA extracted from peripheral white blood cells. Genetic risk for NAT2 genotype was analyzed by smoking index (SI, cigarettes smoked per day x years of smoking)., Results: The frequency of NAT2 slow genotype was 80.6% in patients with laryngeal carcinoma and 60.7% in the controls, the difference of which was statistically significant (chi(2) = 5.70, P = 0.017). The odds ratios were 2.70 (95% CI 1.19 approximately 6.11). Among the individuals with NAT2 slow genotype at high level of cigarette smoking, there was a significantly higher risk of 5.64 (95% CI 1.77 approximately 17.92), while those at low level were considered the reference group (OR 1.38, 95% CI 0.42 approximately 4.52)., Conclusion: NAT2 slow genotype increases the risk of susceptibility to laryngeal carcinoma. The combined effect of NAT2 slow genotype and exposure to smoking is observed during the development of laryngeal cancer.

Objective: To assess the quality of life and relevant factors following laryngectomy., Methods: Quality of life was evaluated in 42 laryngeal cancer and hypopharyngeal cancer patients following laryngectomy and in 38 controls. The assessment included General Quality of Life Inventory, University of Washington Quality of Life Head and Neck Questionnaire and a study specific questionnaire., Results: The laryngectomized patients reported significant lower scores of quality of life than the controls in many aspects of physical health, psychological health and social function dimensions. For patients, the most important dimension affecting quality of life was psychological condition, and the others were physical function, social function, and economic condition in turn; while for the controls, they were of opposite order. The significant factors affecting quality of life in patients following total laryngectomy were their concern about prognosis, disfigurement, decannulation, employment, speech and breathing conditions. The most important factor affecting psychological condition was physical function, while psychological condition was the most important factor affecting social function. Items ranked in the top five included those related to physical function, economic condition, psychological condition, social situation and social communication., Conclusion: More attention should be paid to research about quality of life. The quality of life of patients undergone laryngectomy is affected by many factors. Through the integration of psychological, clinical and social interventions, the quality of life of patients may have an overall improvement.

Objective: To explore the surgical methods and evaluate the long-term result of laryngectomy in patients with supraglottic laryngeal cancer., Methods: 182 patients with supraglottic laryngeal carcinoma underwent operation from 1979 to 1999, with stage I 11, stage II 45, stage III 49 and stage IV 77 lesions. The choice of surgical procedure was decided with the disease condition of the larynx. The surgical procedures proposed by TD Wang were adhered to as: minor partial laryngectomy 36, major partial laryngectomy 85, subtotal partial laryngectomy with laryngoplasty 22 and total laryngectomy 39., Results: The ultimate rate of larynx preservation was 78.6% (143/182) with 69.8% (88/126) in stage III and IV diseases. The decannulation rate was 81.8% in cases with preservation of laryngeal function. The overall 3- and 5-year survival rates were 82.9% and 67.3%, with 76.88% and 57.4% in the advanced (stage III and IV) cases who survived with preserved laryngeal function. They were 82.5% and 67.0% in similar advanced cases who were treated by total laryngectomy. The difference in the survival rates between these two groups was not statistically significant., Conclusion: It is suggested that preservation of the laryngeal function be possible for advanced supraglottic laryngeal carcinoma without compromising the remote survival rate. To improve the rate of larynx preservation, one should follow the surgical methods suggested.