保留喉功能的梨状窝癌的综合治疗

探讨综合治疗对保留喉功能的梨状窝癌的作用。方法：对梨状窝癌进行保留喉功能治疗的３３例进行回顾性分析。（１）３３例术前分别给予１周期或２周期诱导化疗;（２）手术治疗经化疗后的肿瘤切除;（３）术后放射治疗。结果：化疗后有效率４２．４％。３年生存率５４．８％,５年生存率３８．７％。     

喉功能保留的梨状窝癌外科治疗

目的　评价喉功能保留梨状窝癌的手术治疗效果。方法　回顾性分析了 1974～ 1994年 6月我院初治的 44例经保留喉功能手术治疗的梨状窝癌病例。其中T110例 ,T2 14例 ,T3 18例 ,T42例。 2例术后放射治疗 ,42例术前放射治疗。原发灶术式包括 :36例梨状窝切除术 ;8例喉及下咽部分切除术。结果　 44例 5年生存率为 5 0 % ,I期为 80 % ,II期为 71 43% ,III期为 5 2 9% ,IV期为2 6 7%。总的局部控制率为 81 8%。T3 加T4 的 5年生存率为 45 %。T3 加T4 的 5年局部控制率为75 % (15 /2 0 )。结论　综合治疗过程中选择适宜患者 ,行保留喉功能的梨状窝癌手术 ,可取得满意的治疗效果。术前放射治疗有助于梨状窝癌尤其是T3 梨状窝癌患者喉功能的保留。     

梨状窝癌的治疗和生存分析

目的探讨梨状窝癌治疗的疗效和影响预后因素。方法对浙江省肿瘤医院1995年12月至2002年12月收治的62例梨状窝癌手术治疗病例进行回顾性分析。其中T1期13例，1、2期17例，T3期12例，T4期20例。4例行术前放疗，40例行术后放疗，18例行单纯手术治疗。原发灶术式包括：13例梨状窝切除术；20例下咽部分切除及喉部分切除术；21例下咽部分切除及喉全切除术；8例下咽全切除、喉全切除及食管拔脱加胃代食管术。结果采用Kaplan—Meier法行生存分析，生存曲线显示总的3年、5年生存率分别为42．3％和27．8％，保留喉功能组和未保留喉功能组的3年生存率分别为51．9％和29．9％，5年生存率分别为39．5％和11．2％，两组差异有统计学意义（x^2=4．14，P〈0．05）。Cox回归模型分析显示T分期、是否行手术联合放疗的综合治疗是影响患者预后的独立因素。结论早期诊断、早期治疗以及综合治疗可提高梨状窝癌的生存率；早期患者及部分适宜的进展期患者行保留喉功能手术可提高患者牛活质量并取得较为满意的治疗效果。     

梨状窝内侧壁癌的手术治疗

目的：探讨切除梨状窝内侧壁癌并保留喉功能手术的可行性及疗效。方法: 1990～2001年共手术治疗122例梨状窝内侧壁癌,其中87例行保留喉功能的梨状窝内侧壁癌切除术, T1、T2期患者行梨状窝切除术,将声门旁间隙组织一并切除,T3、T4期患者行梨状窝切除＋部分喉切除术,并根据肿瘤范围切除其他受累组织,以局部残留黏膜、胸大肌肌皮瓣、结肠上徙进行修复。35例未保留喉功能。术后均给予放射治疗。结果: 全部患者的3、5年生存率分别为67.2％（82/122）、45.1％（55/122）,其中喉功能保留组3、5年生存率分别为71.3％（62/87）、48.3％（42/87）,喉功能不保留组分别为57.1％（20/35）、37.1％（13/35）。喉功能保留组全部恢复呼吸、发音及吞咽保护者占71.3%（62/87）,部分恢复发音及吞咽保护占28.7%(25/87)。结论:在彻底切除肿瘤的前提下,对梨状窝内侧壁癌患者行喉功能保留手术是可行的。     

梨状窝癌的手术治疗与喉功能保留

目的：探讨梨状窝癌外科治疗与喉功能保留的可行性。方法：分析42例保留喉功能梨状窝癌切除患者的手术方法、并发症、生存率等。结果：术后拔管率为61．9％（26／42）,3、5年生存率分别为76．1％和66.6％,并发症发生率为31．0％（13／42）。结论：保留喉功能梨状窝癌手术适用于T1、T2及经过仔细选择的Ⅲ、Ⅳ期肿瘤患者,该术式不影响患者的生存率,并能提高患者的生存质量。     

保留喉功能的下咽癌切除术

本文报道了保留喉功能的下咽癌切除术７２例，其中梨状窝癌４８例，环后癌５例，下咽上区癌６例及下咽后壁区癌１３例，绝大多数病变为Ⅲ期（３３）和Ⅳ期（２２）．均为鳞癌。术后喉功能完全恢复４５例，部分恢复２６例，功能丧失１例。５年存活率分别是梨状窝癌为４３％，下咽上区癌５０％，环后癌６０％，而下咽后壁癌无１例存活５年。局部复发４例均位于咽部，无１例发生于保留的残喉。本文描述了手术适应证，手术类型和重建方法。作者等认为保留喉的正常部分，重建喉功能，并不影响肿瘤的彻底切除。     

晚期喉咽癌围手术期放疗及喉功能保留

目的 评价局部晚期喉咽癌保留喉功能的手术选择及治疗效果.方法 回顾性分析了1976年1月～1999年12月我院初治的、经手术治疗的全部或部分保留了喉功能的47例T3级、T4级喉咽癌患者.其中咽后壁癌3例(均为T3级),梨状窝癌44例(36例T3级,8例T4级).术前放疗44例;手术加术后放疗3例.根据原发或放疗后的病变范围行手术治疗,其中:梨状窝切除术21例;梨状窝及部分喉切除术16例;喉咽部分切除,近全喉切除术10例.结果 Kaplan-Meier方法计算全组5年生存率为53.9%.Ⅲ、Ⅳ期5年生存率分别为59%和50.2%.3种术式局部复发率分别为14.3%、6.3%和21.4%.结论 对晚期喉咽癌的患者,可以选择病例进行喉咽根治手术,保留全部或部分喉功能.     

保留喉功能的下咽癌手术

目的　探讨下咽癌保留喉功能手术的可行性、技术操作及疗效。方法　回顾性分析１９７８ ～１９９６ 年间３０５ 例（ 男２７９,女２６;年龄１４ ～７７ 岁） 经手术治疗的下咽恶性肿瘤（１９８７ 年ＵＩＣＣ分期：Ｉ期６ 例;ＩＩ期１２ 例;ＩＩＩ期８２ 例;ＩＶ期２０５ 例） ,其中梨状窝癌２３４ 例,环后癌２１ 例,下咽后壁区癌３５ 例,下咽上区癌１５ 例。２０６ 例（６７．５４ ％ ,分期：Ｉ期６ 例;ＩＩ期１２ 例;ＩＩＩ期６５ 例;ＩＶ期１２３ 例） 作了喉功能保留手术,９９ 例（３３．４６％ ,ＩＩＩ期１７ 例;ＩＶ期８２ 例） 未保留喉功能。术后根据需要给予放射治疗（２８５ 例） ,剂量５５～７５Ｇｙ。结果　３０５ 例总５ 年生存率为４４．８％ （８６／１９２）。各期分别为Ｉ期８３％ ;ＩＩ期７１％ ;ＩＩＩ期５８％ ;ＩＶ期３６ ％ 。２０６ 例喉功能保留组,喉功能（ 呼吸、发音及吞咽保护） 全恢复１３９ 例（６７．５％ ） ;部分（ 发音及吞咽保护）恢复６７ 例（３２．５％ ） ;５ 年生存率为４８％ （６６ 例） 。保留喉功能组与不保留喉功能组的５ 年生存率、并发症、肿瘤残存率及术后吞咽成功率,经统计学分析差异均无显著性。结论　只有较少数下咽癌患者需     

保留喉功能的梨状窝癌的手术治疗

目的 探讨保留喉功能的梨状窝癌的手术治疗的可行性及相关技术方法。方法1978-1996年山东大学齐鲁医院耳鼻咽喉科对230例梨状窝鳞癌进行手术治疗，根据1997年UICC分期标准，Ⅰ期6例，Ⅱ期10例，Ⅲ期91例，Ⅳ期123例。根据病变的具体情况，采用不同的肿瘤切除方式和多种方法进行组织缺损的修复。在彻底切除肿瘤的前提下，保留可利用的正常组织进行咽喉功能重建。共行保留喉功能手术158例，不保留喉功能手术72例。术后根据需要行辅助放射治疗。结果全组患者3年生存率为67．4％(155／230)，5年生存率为48．3％(111／230)，各期5年生存率分别为I期5／6，Ⅱ期70．0％(7／10)，Ⅲ期57．1％(52／91)，Ⅳ期38．2％(47／123)。保留喉功能组3、5年生存率分别为67．7％(107／158)和50．0％(79／158)，不保留喉功能组3、5年生存率分别为66．7％(48／72)和43．1％(31／72)。158例保留喉功能，其中喉功能全部恢复(发音、呼吸、吞咽保护)占75．3％(119／158)，喉功能部分恢复(发音、吞咽保护)占24．7％(39／158)。结论保留喉功能的梨状窝癌的手术治疗是可行的，根据具体情况合理选用咽喉功能重建方法是提高患者生活质量的重要保证。     

保留喉功能的梨状窝癌手术14例

目的 探讨保留喉功能的梨状窝癌手术方法和适应证。方法 梨状窝癌患者14例, Ⅰ期3例, Ⅱ期5例, Ⅲ期4例, Ⅳ期2例。行保留喉功能的手术治疗, 术后放疗40～55 Gy。结果 随访5年, 14例均恢复发音功能, 12例拔管。3年生存率为64.29%, 5年生存率为42.86%。结论 经严格术前评估, 大部分梨状窝癌患者可通过精细手术保留喉正常组织, 并通过多种修复方法恢复喉的全部或部分功能。     

梨状窝内侧壁癌切除与喉功能保留

目的 探讨梨状窝内侧壁癌切除喉功能保留犬的技术方法和临床疗效。方法 回顾分析手术治疗的梨状窝内侧壁癌71例。其中49例行喉功能保留术;22例未保存喉功能。喉功能保留手术方法：①切除范围：声带活动正常者行患侧水平上半喉＋梨状窝内侧壁切除;声带活动受限者行同侧水平半喉＋声门旁间隙＋梨状窝内侧壁切除;声带固定者行患侧垂直半喉＋梨状窝内侧壁和部分梨状窝外侧壁切除,梨状窝尖受累者切除范围扩大到环状软骨环和颈段食管;②修复:喉修复对利用会厌、甲状软骨膜、带状肌肌筋膜、颈前皮瓣修复喉缺损;梨状窝修复对缺损范围小者用下咽粘膜瓣或残缘粘膜后直接讨合,对缺损范围大者用胸大肌肌皮瓣转移及胸三角皮瓣修复;③颈淋巴结处理：71例中65例（91．5％）行颈清扫术,其中同侧颈清扫术39例,双侧颈清扫术26例;④术后全部病例予以辅助放射性治疗,剂量60－75Gy。结果 寿命表法统计3年、5年生存率：喉功能保留组分别为63．4％和49．6％;喉功能不保留组分别为52．4％和42．4％。喉功能保留组喉功能全部恢复者占71．4％（35／49）,部分恢复者占28．6％（14／49）。结论 梨状窝内侧壁癌易侵入喉部,但多数病例在彻底切除肿瘤病灶的前提下保留喉功能是可行的。     

Five hundred cancers of the larynx and pyriform sinus: Results of treatment by radiation and surgery

Three hundred eighty cancers of the larynx and 120 of the pyriform sinus were treated in the 15 years from 1958-1973 at Yale-New Haven Hospital. They were studied for response to treatment by surgery, radiation or a combination of the two. Overall control rates in the entire group of 500 were 51% for radiotherapy, 51% for surgery. Further analysis showed significant differences in the results obtained by stage and by location for surgery and radiotherapy. The total number of cases treated by combined therapy was relatively small, except for pyriform sinus. Radiotherapy success showed a steep gradient from 82% in Tl lesions to 5% in T4. The gradient for surgery was less steep with 64% success for Tl and 40% for T4. Both radiotherapy and surgery were most successful in glottic cancer and least successful in the pyriform sinus. However, the success range varied more with radiation than with surgery (83% success in glottic cancer, 5% in pyriform sinus cancer for radiotherapy; 81% in glottic cancer and 24% in pyriform sinus for surgery). Late primary recurrences (3 years or more after radiation therapy) developed only in the glottic group. Recurrent cancer at the primary site in non-glottic lesions appeared within 2 years after radiotherapy in 65 of the 66 local recurrences. Similarly, 77 of the 82 local recurrences of non-glottic cancer after surgery appeared within 2 years. With only 1 exception in 34 cases, surgical salvage of radiation failures succeeded only in glottic cancer. Of the 136 T1 glottic lesions there were no discernible regional metas-tases. In the remaining 73 glottic T2 and T3 lesions, cervical node me-tastases developed in 8 lesions. Supraglottic cancer was the most likely to produce cervical node metastasis from an early primary lesion (5 Tl lesions among 10 supraglottic lesions with unrecognized positive nodes). Eight of the 65 patients with fixed cervical node metastasis were controlled with no evidence of disease after 3 years. Among the treatment failures, most of those in the radiotherapy group were due to uncontrolled primary disease (72%). The failures among the surgical group were due mainly to metastasis (72%). Final controls obtained by surgery, radiotherapy, combined treatment and secondary salvage of radiation or surgical failures were as follows: glottic 82%; supraglottic 58%; transglottic 58%; subglottic 60%; pyriform sinus 17%.     

保留喉功能梨状窝癌的手术及诊疗体会

目的 探讨梨状窝癌喉功能保留及功能重建方法。 方法 回顾性分析2004年6月至2015年10月102例保留喉功能的梨状窝癌的治疗过程,根据2002年UICC分期标准, Ⅰ期9例,Ⅱ期11例, Ⅲ期47例,Ⅳ期35例。根据术前评估分别采取咽侧入路、舌骨区入路和声门旁间隙入路切除肿瘤,肿瘤切除后同时行组织缺损修复和咽喉功能重建。93例术后实施了放疗。 结果 患者术后均恢复顺利,感染和咽瘘1例,所有修复方法修复材料成活,平均恢复经口进食时间12.47 d。全组患者喉功能重建良好,95例拔除了气管套管。3年、5年生存率分别为59.3%和40.7%。 结论 术前完善的喉镜检查和影像学评估可以为选择合适的手术入路提供指导;良好的手术入路可以为简便手术提供良好的视野、为安全切除肿瘤提供保障;术中通过会厌扭转、甲状腺加固等修复方式,可以有效减轻误咽、减少咽瘘的发生;梨状窝癌由于发现时多为晚期病例,单一的治疗手段往往不能控制病灶,需要加用放疗等措施进行综合治疗以提高局部控制率和生存率。对选择的梨状窝癌患者采取适合的手术入路和修复方式,可彻底切除肿瘤,并能保留和重建较好的咽喉功能。     

梨状窝癌术前同步放化疗对手术并发症影响的临床研究

目的 比较梨状窝癌术前同步放化疗与术前单纯放疗的术后并发症及喉保留率.方法 回顾性分析中国医学科学院肿瘤医院2002年3月至2009年3月治疗的梨状窝鳞癌,共46例,根据是否同步化疗分为两组:术前同步放化疗组,共23例,采用顺铂单药50 mg每周一次的方案,21～44 d(中位数31 d)后手术;术前单纯放疗组,共23例,17～40 d(中位数28 d)后手术.结果 术前同步放化疗组和术前单纯放疗组手术并发症发生率分别30.4%和39.1%,差异无统计学意义(χ2=0.099,P＞0.05).1年喉保留率两组分别为52.2%和17.4%,差异有统计学意义(χ2=6.133,P＜0.05);术前同步放化疗组和术前单纯放疗组的1年局部区域控制率和无瘤生存率分别为89.9%、56.3%和71.1%、47.1%,差异均有统计学意义(χ2分别为5.606和4.335,P值均＜0.05).结论 术前同步放化疗并未明显增加手术后并发症发生率,对增加局部缓解率和提高喉保留率有积极的作用;术前同步放化疗能提高局部和区域控制率,减少局部及颈部复发,但尚需积累更多的资料进一步分析.

Abstract：

Objective To compare the surgery complications and laryngeal function sparing rate after preoperative concurrent chemoradiotherapy and preoperative radiotherapy of pyriform sinus cancer.Methods Forty-six patients with squamous cell carcinoma of pyriform sinus from March 2002 to March 2009 were retrospectively analyzed.Concurrent chemotherapy with radiotherapy (CRT + S group) was conducted in twenty-three patients.Cisplatin (50 mg/weekly)was mostly applied.Twenty-three patients were treated with radiation only (RT + S group).Surgery was conducted after a break-time of 21 - 44 days (median,31 d)and 17 -40 days (median,28 d),respectively.Results The complication rate of CRT + S group and RT + S group were 30.4％ and 39.1％ respectively,no significant differences was found (χ2 =0.099,P ＜0.05).The one-year laryngeal function sparing rate of the two groups were 52.2％ and 17.4％ respectively ,with significant differences(χ2 = 6.133,P ＜ 0.05).The one-year local regional control rate and disease free survival rate for the CRT + S group were 89.9％,71.1％ ,and for RT + S group were 56.3％,47.1％,P level were 0.018 and 0.037,respectively.There was significant differences in one year local regional control rate and disease free survival rate between the two groups.Conclusion The addition of concurrent chemotherapy to preoperative radiotherapy in patients with pyriform sinus cancer does not increase the incidence of surgery complications.Chemotherapy improves the remission rate and appears to increase the laryngeal function sparing rate. Preoperative concurrent chemoradiotherapy can improve the local and regional control,and certainly,more investigations will be needed.     

Near-total laryngectomy in advanced cancers of the larynx and pyriform sinus: a comparative study of morbidity and functional and oncological outcomes.

This prospective study, performed from 1991 to 1996, analyzes the differences in oncological safety, functional utility, and surgical morbidity in 14 advanced lesions of the larynx (10 T3 and 4 T4; 7 N+) and 40 pyriform sinus lesions (1 T2, 20T3, and 19 T4; 29 N+) subjected to Pearson near-total laryngectomy. The laryngeal cancer patients healed much faster, with a minimal wound complication rate of 28%, in comparison to the 68% rate encountered in the pyriform sinus cases (p < .05). The 3-year disease-free survival rate for the laryngeal cancers was 74%, while the 5-year survival rates for pyriform sinus cases were 66% for medial wall lesions and 54% for lateral wall lesions. Lung-powered shunt speech deemed qualitatively superior by acoustic analysis was obtained in 81% of the individuals (93% in laryngeal cases and 76% in pyriform sinus cases). Aspiration-free deglutition was achieved by 90% over periods ranging from 15 to 30 days. This study conclusively attests to the therapeutic efficacy of near-total laryngectomy for advanced lesions of the larynx and pyriform sinus that are unsuitable for radiotherapy, that are deemed too large or risky (because of aspiration) for partial laryngectomy, and that in the past would have merited total laryngectomy.     

Pyriform sinus cancer: a clinical and laboratory study.

In our patient population, cancer of the hypopharynx arose 19 times as often in the pyriform sinus as in the postcricoid space (152:8). Most of the growths were far advanced when first seen (90% T3), and enlarged cervical nodes were present in 66% of the patients. Three year survival rates free of disease were as follows: primary surgical treatment (laryngectomy, radical neck dissection) (8/28) 29%; primary radiotherapy (2/55) 4%; and combined preoperative radiation (12/33) 36%. Serial section studies of 51 surgical specimens indicate that T1 and T2 lesions, especially those confined in the medial wall, are probably curable by radiotherapy. Larger lesions invade deeply into the larynx and resemble transglottic growth in their pattern of spread. Conservation surgery would have been inadequate for all but perhaps one growth in this series of 51 lesions, because of the high rate of invasion by cancer into and through the thyroid cartilage and cricoid ring (22/51). Although surface presentation of this group of pyriform sinus cancers rarely reflected the extent of invasion, each of the 22 growths that invaded portions of the thyroid or cricoid cartilages was characterized by clinical involvement of the apex and lateral wall of the pyriform sinus on laryngoscopy or barium swallow.