喉癌、下咽癌复发的临床分析和治疗转归

目的：探讨喉癌、下咽癌术后复发的原因及挽救性手术的可行性。方法：回顾分析98例复发性喉癌、下咽癌的临床资料。68例行癌复发手术切除及术后常规放疗，其中喉部分切除术后局部复发21例，颈淋巴结转移7例，局部复发并颈淋巴结转移5例；全喉切除术后气管造瘘口复发癌8例；下咽癌切除术后局部复发2例。颈淋巴结转移15例；30例行单纯放疗或姑息性治疗。68例行癌切除术和(或)改良根治性颈清扫术，其中胸大肌皮瓣修补术29例，胃上提代食管下咽15例，游离结肠上徙代下咽食管2例。结果：喉癌手术后1年、3年生存率分别为96.10％和33.33％，下咽癌手术后1年、3年生存率分别为64.71％和5．88％，而单纯放疗或姑息治疗1年及3年的生存率仅为10％和0％。结论：复发性喉癌、下咽癌的预后较差，适当的手术治疗可延长患者生命，提高生存质量。

Clinical analysis and prognosis of recurrent laryngeal and hypopharyngeal carcinoma after surgery

Objective:To investigate the causes of recurrent laryngeal and hypopharyngeal carcinoma and the surgical possibilities.Methods:The clinical data of 98 cases of recurrent laryngeal and hypopharyngeal carcinoma were analyzed retrospectively.68 cases after carcinectomy were performed radiotherapy,among them, 21 cases were local reccurrence, 7 cases were cervical lymphatic metastasis, and 5 cases were local reccurrence and cervical lymphatic metastasis after partial laryngectomy ; 8 cases were stomal reccurrence after total laryngectomy; 2 cases were local reccurence , and 15 cases were lymphatic metastasis after resection of pharyngeal carcinoma. Among 98 cases , 30 cases were not performed reoperation, but conservertive therapy or radiotherapy. 68 patients were performed carcinectomy and /or modified radical neck dissection,of them,the pectoralis myocutaneous flap was applied in 29 cases, the pharyngo-gastric anastomasis in 15 cases , transferring for pharyngo-oesophageal reconstruction with free colon in 2 cases.Result:The survival rates of 1.5 and 3 years were 96.10% and 33.33% after laryngeal carcinoma; 64.71% and 5. 88% after hypopharyngeal carcinoma; 30% and 0% in incurable cases.Conclusion:The overall prognosis of recurring laryngeal and hypopharyngeal carcinoma is poor. A proper surgical treatment in some cases will prolong the patient's lifetime obviously and improve his quality of lives.