喉癌术后局部复发与手术切缘的关系

目的 :探讨喉癌术后局部复发与手术切缘的关系。方法 :对 1991～ 1999年行手术治疗并随访满 3年以上的喉癌患者的临床资料进行回顾性分析 ,分别选取手术切缘、T分期和术后放疗等因素进行统计学分析。结果 :① 16 0例喉癌患者术后局部复发 36例 ,复发率为 2 2 .5 % ;②局部复发与肿瘤的T分期有关 ,差异有统计学意义 ;③切缘≤ 3mm组的局部复发率高于切缘 4～ 5mm组和 >5mm组 ,差异有统计学意义 ;④手术切缘≤3mm的 6 9例中 ,32例行术后放疗的局部复发率低于 37例未行放疗者 ,差异有统计学意义 ;⑤声门型喉癌 5mm的手术切缘与切缘≤ 3mm组相比 ,局部复发率较低 ,差异有统计学意义。而 5mm的手术切缘对声门上型喉癌不够安全 ,与≤ 3mm组相比 ,局部复发率相似 ,差异无统计学意义。结论 :①以 5mm作为声门型喉癌的手术切缘是相对安全的 ;②以 5mm作为声门上型喉癌的手术切缘不够安全 ,如局部条件许可 ,建议以 10mm为安全切缘 ;③对手术切缘不够者行术后放疗可降低局部复发率 ,但不主张因此而放宽对安全切缘的标准。

The relationship between the surgical margin and local recurrence of laryngeal carcinoma

OBJECTIVE: To study the relationship between the surgical margin and local recurrence of laryngeal carcinoma. METHOD: The surgical margin, T staging, postoperative irradiation and the local recurrence of 160 cases of laryngeal carcinoma operated between 1991 and 1999 were retrospectively reviewed and analyzed. RESULT: (1) Of 160 cases of laryngeal carcinoma, local recurrences were occurred in 36 cases (22.5%). (2) Local recurrence was statistically significantly related to the T staging of the tumor. (3) By comparing the local recurrence of 3 groups of patients: surgical margin < or = 3 mm, between 4-5 mm and > 5 mm, the rate of local recurrence of the group with surgical margin less than 3 mm were significantly higher than that of the groups with surgical margin between 4-5 mm and > 5 mm. (4) Of 69 cases with surgical margin less than 3 mm, 32 cases were received the postoperative irradiation, while 37 cases did not undergo. Statistical analysis showed that the local recurrence of the group of patients received postoperative irradiation was significantly lower than that of patients who did not received postoperative irradiation. (5) By analyzing the rate of local recurrence of difference surgical margin in the patients with glottic and supraglottic carcinoma, we found that the 5 mm as a surgical margin was relatively safe for the glottic carcinoma, but it was not the case for the supraglottic carcinoma. CONCLUSION: 5 mm as a surgical margin is relatively safe for the glottic carcinoma, but it is not the case for the supraglottic carcinoma. Therefore, the surgical margin more than 5 mm is proposed for supraglottic carcinoma. For the patients with surgical margin less than 3 mm, postoperative irradiation can effectively reduce the rate of local recurrence, but this does not mean that we can reduce the standard surgical margin during the laryngectomy.