喉癌单纯放疗失败后行喉部分切除术的预后研究

目的探讨喉癌经单纯放疗后原发灶复发的患者行喉部分切除术治疗的临床疗效和预后影响因素。方法回顾性分析根治性喉癌放疗后原发灶复发的20例喉癌患者行喉部分切除术后的临床资料。结果20例患者的3年总生存率为60.0%;其中15例切缘阴性患者3年总生存率为66.7%;5例切缘阳性患者3年总生存率为40.0%;在15例切缘阴性患者中3例(20.0%)复发,其中2例患者出现口咽部肿瘤,1例患者同时出现肿瘤原位复发和淋巴结转移,患者平均无复发生存率为12个月(5~16个月),2年无瘤生存率为66.7%;术后患者均能发音,并恢复吞咽功能,正常进食,平均拔胃管时间13d(6~50d);除3例局部复发未能拔管,1例因放射性喉水肿拔管困难外,余16例均顺利拔管,拔管率80.0%,平均拔管时间为16d(13~124d)。经过筛选的10例患者,术后UW-QOL生活质量评估显示患者的疼痛、活动能力、娱乐、工作、咀嚼、吞咽、说话交流等方面均有所改善;多因素分析得出原发瘤位置是生活质量的主要影响因素。结论早期喉癌单纯放疗后原发灶复发患者行喉部分切除术可以获得较好的疗效。

Study on prognosis of partial laryngectomy after failure of simple radiotherapy in laryngeal carcinoma

Objective To explore the clinical curative effect and prognostic influencing factors of partial laryngectomy in the pa‐tients with recurrent primary laryngeal carcinoma after failure of radiotherapy .Methods The clinical data in 20 cases of recurrent primary laryngeal carcinoma undergoing partial laryngectomy after failure of radiotherapy were retrospectively analyzed .Results Among 20 cases ,the 3‐year overall survival rate was 60 .0% ;which in 15 cases of negative resection margins was 66 .67% ;while which in 5 cases of positive resection margins was 40 .0% ;among 15 cases of negative resection margins ,3 cases(20 .0% ) recurred , in which 2 cases appeared oropharyngeal tumor and 1 case appeared tumor recurrence in situ and lymph node metastasis ,the re‐lapse‐free survival rate was 12 months(5-16 months) and the 2‐year disease‐free survival rate was 66 .7% ;the postoperative cases could pronounced and recovered the swallowing function with normal eating ,the average gastric tube removal time was 13 d (6-50 d);except 3 cases without removing the gastric tube due to partial recurrence and 1 case of difficult gastric tube removal due to radi‐oactive laryngeal edema ,remaining 16 cases succeeded in tube removal ,the tube removal rate was 80 .0% ,the average tube removal time was 16 d(13-124 d) .The UW‐QOL living quality evaluation in 10 screened cases demonstrated that the aspects of pain ,activ‐ity ability ,entertainment ,work ,chewing ,swallowing and talk exchange were improved to some extents .The multivariate analysis indicated that the location of primary carcinoma was the main influencing factor of living quality .Conclusion Conducting partial laryngectomy for recurrent primary laryngeal carcinoma after failure of radiotherapy in the patients with early laryngeal carcinoma could obtain better curative effect .