晚期喉癌的综合治疗分析

目的　评价综合治疗在晚期喉癌中的应用价值。方法　回顾性分析 1984～ 1997年河北医科大学第四医院耳鼻咽喉科 2 0 4例晚期喉癌 (不包括远处转移病例 )经单纯手术、手术 放射治疗、手术 放射治疗 化学治疗等不同方法治疗的疗效。结果　总的 3、5年的生存率分别是 70 1%(14 3/2 0 4 )和 6 1 8% (12 6 /2 0 4 )。其中 ,综合治疗组 5年生存率为 6 8 2 % (90 /132 ) ,单纯手术组 5年生存率为 5 0 0 % (36 /72 ) ,差异有显著性意义 (χ2 =3 2 6 ,P <0 0 5 )。单纯手术组的复发率为 2 7 8% ,综合治疗组为 2 2 7% ,二者之间差异无显著性意义 (χ2 =0 6 5 ,P >0 0 5 )。综合治疗组远处转移率为10 6 % ,单纯手术组为 2 0 8% (χ2 =3 99,P <0 0 5 ) ,二者之间差异有显著性意义。术前放射治疗组伤口感染及咽瘘分别为 15 6 % (10 /6 4 )和 18 8% (6 /32 ) ,术前未放射治疗者伤口感染及咽瘘分别为15 7% (2 2 /14 0 )和 14 1% (10 /71) ,二者差异均无显著性意义 (χ2 =0 0 0 33,P >0 0 5 ;χ2 =0 37,P >0 0 5 )。结论　对晚期喉癌采用综合治疗的方法比单纯手术疗效好 ;术前放射治疗不增加术后感染和咽瘘的发生。

Combined treatment for advanced laryngeal carcinoma

Objective To assess the efficacy of the combined therapy for advanced laryngeal carcinoma. Methods 204 cases of advanced laryngeal carcinoma were treated in this department from 1984 to 1997. Patients were treated by surgery alone or combined therapy in cluding of surgery,radiotherapy and chemotherapy. Results The overall 3 and 5 year survival were 70.1%(143/204) and 61.8%(126/204) respectively. 5-year survival rate of the combined therapy group was 68.2%(90/132),whereas,5-year survival was only 50.0%(36/72) for surgery alone group ( P <0.05). There was no statistical differences between surgery alone group and the combined therapy group in the local recurrences ( P >0.05) but distant metastases ( P <0.05). There were also no statistical differences between the preoperative radiotherapy group and the non-preoperative radiotherapy group in the terms of infection and fistula ( P >0.05). Conclusion The results suggest that the combined therapy was more effective than surgery alone for the treatment of the advanced laryngeal carcinoma. Preoperative radiotherapy did not increase the incidences of infection and fistula.