全喉切除术后气管造口复发癌

目的 探讨喉癌、下咽癌全喉切除术后气管造口复发癌病因、诊断及治疗，提出气管造口复发癌预防措施。方法 回顾性分析16例喉癌、下咽癌全喉切除术后气管造口复发癌临床资料，对比手术和非手术治疗的效果。结果 16例气管造口复发癌全喉切除术前均有肿瘤声门下侵犯，5例术后绝缘阳性；手术治疗11例，5例术后病理证实为淋巴结转移；术后生存5－68个月，4例（4／9）存活3年以上；放射治疗或未治疗5例，生存3－7个月；手术明显延长生命（P＜0．01）。结论 气管造口复发癌病因可能与肿瘤残存、种植、淋巴结转移、肿瘤分化有关；预后差，应重在预防。全喉手术肿瘤的彻底切除，标本切缘的显微监控，精细的颈淋巴清扫手术是降低本病发生率的重要保证。

Postlaryngectomy peristomal recurrence]

OBJECTIVE: To study the etiopathology, diagnosis and management of peristomal recurrence after laryngectomy, and the prevention of peristomal recurrence. METHODS: Retrospective analysis of clinical management and outcomes of 16 cases of peristomal recurrence. RESULTS: The subglottic extension of laryngeal cancer and peritracheal metastasis may result in peristomal recurrence. The stomal resection with mediastinal dissections and the use of the pectoralis major myocutaneous flap were done. The survival period of 11 cases surgically treated was longer than that of 5 cases irradiated or untreated. CONCLUSION: Surgical management would improve the survival, but overall prognosis is dismal and attention should be focused on prevention. It is evident that early diagnosis of stomal recurrences will yield good results.