喉癌全喉切除术后局部复发的临床特点和治疗转归

目的　了解喉癌全喉切除术后局部复发的临床特点和治疗效果。方法　回顾性分析 1989年～ 1996年 193例喉癌进行全喉切除术患者的临床资料 ,对术后局部复发的 18例患者进行总结 ,明确局部复发的部位、时间以及再次治疗的效果。结果　全喉切除术后 18例 (9.3 % )患者出现局部复发。局部复发部位 :气管造瘘口复发 6例 (3 3 .3 % )、咽复发 11例 (61.1% )、气管造瘘口合并咽复发 1例 (5 .6% )。复发患者中有 2例同时合并颈段食管受累 (11.1% )。局部复发的时间为 6～ 2 0个月 ,平均 10 .2个月。复发患者的 3年和 5年累计生存率分别为 2 0 .0 %和 0。复发后距死亡的间隔时间为 2～ 5 1个月 ,平均 2 3 .7个月。造瘘口复发和咽复发患者的 3年生存率分别为 3 3 .3 % (2 /6)和 63 .6% (7/11)。术后复发患者再次行局部手术的 7例生存均超过 3年 ,经再手术治疗和非手术治疗的局部复发患者的生存率相互比较有显著性差异 (P <0 .0 5 )。结论　全喉切除术后局部复发主要包括造瘘口和咽部复发。局部复发后的预后很差。咽部复发者较造瘘口复发者预后好 ,应采取更积极的手术治疗

The Clinical Characteristics and Prognosis of Primary Recurrence after Total Laryngectomy in Laryngeal Carcinoma

Objective To investigate the clinical characteristics and prognosis of primary recurrence after total laryngectomy in laryngeal carcinoma.Methods 193 cases diagnosed as laryngeal carcinoma who underwent total laryngectomy between 1989 and 1996 in our hospital were reviewed.18 cases with primary recurrence after total laryngectomy were summarized to study the primary recurrence site,time,treatment after relapse and prognosis.Results 9.3%(18/193) of patients with laryngeal carcinoma presented local recurrence after total laryngectomy.The recurrence sites in all patients were classified into tracheal stomal recurrence(6/18, 33.3% ),pharyngeal recurrence(11/18,61.1%) and stomal combined with pharyngeal recurrence(1/18,5.6%).There were 2 patients with esophageal infiltration(2/18,11.1%).The primary recurrence time was 6 to 20 months with an averaged time of 10.2 months.The 3 year and 5 year cumulative survival rate was 20.0% and 0 respectively in the patients with primary recurrence.The surival time after primary recurrence was 2 to 51 months with an averagtime of 23.7 months.The 3 year survival rate in patients with postoperative stomal recurrence and pharyngeal recurrence was 33.3%(2/6) and 63.6%(7/11) respectively.Seven patients who received second surgical treatment after postoperative local recurrence survived for more than 3 years.The survival rate was significant different between patients with and those without second operation after primary recurrence( P <0.05).Conclusion Most of the primary recurrences after total laryngectomy are tracheal stomal and pharyngeal recurrences.The prognosis of primary recurrence after total laryngectomy is very poor.Pharyngeal recurrence has better survival rate than stomal recurrence,which indicates more active surgical treatment.