保留喉功能的下咽癌手术

目的　探讨下咽癌保留喉功能手术的可行性、技术操作及疗效。方法　回顾性分析１９７８ ～１９９６ 年间３０５ 例（ 男２７９，女２６；年龄１４ ～７７ 岁） 经手术治疗的下咽恶性肿瘤（１９８７ 年ＵＩＣＣ分期：Ｉ期６ 例；ＩＩ期１２ 例；ＩＩＩ期８２ 例；ＩＶ期２０５ 例） ，其中梨状窝癌２３４ 例，环后癌２１ 例，下咽后壁区癌３５ 例，下咽上区癌１５ 例。２０６ 例（６７．５４ ％ ，分期：Ｉ期６ 例；ＩＩ期１２ 例；ＩＩＩ期６５ 例；ＩＶ期１２３ 例） 作了喉功能保留手术，９９ 例（３３．４６％ ，ＩＩＩ期１７ 例；ＩＶ期８２ 例） 未保留喉功能。术后根据需要给予放射治疗（２８５ 例） ，剂量５５～７５Ｇｙ。结果　３０５ 例总５ 年生存率为４４．８％ （８６／１９２）。各期分别为Ｉ期８３％ ；ＩＩ期７１％ ；ＩＩＩ期５８％ ；ＩＶ期３６ ％ 。２０６ 例喉功能保留组，喉功能（ 呼吸、发音及吞咽保护） 全恢复１３９ 例（６７．５％ ） ；部分（ 发音及吞咽保护）恢复６７ 例（３２．５％ ） ；５ 年生存率为４８％ （６６ 例） 。保留喉功能组与不保留喉功能组的５ 年生存率、并发症、肿瘤残存率及术后吞咽成功率，经统计学分析差异均无显著性。结论　只有较少数下咽癌患者需

Preservation of laryngeal function in surgical treatment of hypopharyngeal carcinoma

Objective To study of the feasibility, the surgical techniques and the results of laryngeal function preservation in surgical treatment of hypopharyngeal carcinoma Methods A retrospective review of 305(279 males, 26 females, ages ranging from 14 to 77 years) cases with malignant neoplasms of the hypopharynx that were treated from 1978 to 1996 were accomplished Of the 305 (stage I, 6; II, 12; III, 82; IV, 205) cases, 234 were originated from pyriform sinus, 21 from postcricoid, 35 from posterior pharyngeal wall and 15 from superior hypopharynx Two hundred and eighty five patients received 55 75 Gy postoperative radiotherapy Results The overall 5 year survival rate of 305 patients was 44 8%; for stage I , the survival rate was 83% ; stage II, 71% ; stage III, 58% and stage IV, 36 5% Of the 305 patients, 206 cases (67 54%, stage I, 6; II, 12; III, 65; IV, 123) were surgically treated with laryngeal functions preserved and 99 (32 46%, stage III, 17; IV, 82) total laryngectomy There were no significant differences in 5 year survival between the functionally preserved group and none functional group Among the 206 functional preserved patients, 139(67 5%) had all functions preserved (voice, respiration and deglutition) and 67(32 5%) partially preserved (voice and deglutition) Conclusion Only a few patients (31/305, 10%) of hypopharyngeal carcinomas require total laryngectomy, and the preservation of the normal part of the larynx is feasible for the eradication of tumor and preservation of laryngeal function