气管造口复发癌的处理

目的探讨气管造口复发癌的治疗方法.方法对中国医学科学院肿瘤医院1994年6月～2001年8月诊治的23例气管造口复发癌的临床资料进行了回顾性的分析.外院转来病例20例,本院3例.分析复发的原因,探讨不同手术的可行性,对比手术和非手术治疗的效果. 结果 23例气管造口复发癌中,未行手术病例5例,均在1～6个月死亡,平均存活5.7个月.接受手术18例中,随诊6个月～7年2个月,生存超过6个月的16例,1年生存率40.7%,3年生存率20.4%.术后咽瘘6例,其中1例伴有颈总动脉大出血,抢救成功;1例伴有皮瓣局部坏死,术后1周颈总动脉破裂大出血死亡;1例偏瘫昏迷后抢救成功,并同时皮瓣局部坏死.秩和检验,手术患者的生存时间与未手术者差异有显著性(t=17,P<0.05).结论气管造口复发癌预后极差,应注意预防.气管造口复发癌与声门下侵犯、喉前气管食管沟淋巴结转移、局部肿瘤残存和种植有关.对适合的病例行适当的手术治疗,可延长患者生命,减少痛苦,提高生存质量.

The management of stomal recurrence after laryngectomy

Objective To study effective prevention and treatment of stoma recurrence after laryngectomy. Methods A retrospective review of 23 patients with stomal recurrence after laryngectomy was conducted. Among all 23 cases, 20 cases were referred to Cancer Hospital of Chinese Academy of Medical Science from other hospitals. The etiopathology of stomal recurrence after laryngectomy, feasibilities of various kinds of operative treatment and outcomes of clinical management in this series were analyzed. Results The subglottic extension and invasion of paraglottic portion of laryngeal cancer and peritreacheal metastasis may result in stomal recurrence. The survival period of 18 cases surgically treated was longer than that of 5 cases untreated or irradiated and/or chemotherapied. The 1- and 5-year survival rates were 40.7% and 20.4%, respectively. The common complication was pharyngeal fistula. Surgical treatment may relieve local pain, improve breathing, resume swallowing and decrease cancer ulcer bleeding. Conclusions The overall prognosis of peristomal recurrence after laryngectomy was awful and dismal. Prevention should be stressed in surgical treatment of the subglottic extension, invasion of paraglottic portion and peritreacheal node metastasis. A proper surgical treatment in some cases of stomal recurrence would prolong the lifetime and advance the life quality of the patients.