保留喉功能的下咽后壁癌的手术治疗

目的：探讨保留喉功能的下咽后壁癌手术治疗的可行性及相关技术方法。方法：对35例下咽后壁癌患者进行手术治疗，根据病变的具体情况，采用不同的肿瘤切除方式和多种方法进行组织缺损的修复。在彻底切除肿瘤的前提下，保留可利用的正常组织进行咽喉功能重建。行保留喉功能手术27例，未保留喉功能手术8例。术后根据需要行辅助放疗。结果：本组病例3年生存率为45．7％，5年生存率为28．6％。27例保留喉功能，其中喉功能全部恢复（发声、呼吸和吞咽保护）16例，占45．7％，喉功能部分恢复（发声、吞咽保护）11例，占31．4％。本组患者死于颈部淋巴结转移9例，肿瘤局部复发10例，肺部转移2例，颈部大出血1例，心脏病2例，原因不明1例。结论：保留喉功能的下咽后壁癌的手术治疗是可行的，熟练掌握肿瘤切除技术并根据需要合理选用咽喉功能重建方法是提高患者生活质量的重要保证。

Preservation of laryngeal function in surgical treatment of posterior hypopharyngeal wall cancer

Objective:To explore the feasibility and the related surgical techniques of laryngeal function preservation in surgical treatment of posterior hypopharyngeal wall cancer.Method:Thirty-five cases with posterior hypopharyngeal wall cancer were treated surgically. The methods of removing tumor and repairing surgical defects were depended on the extension of lesions. The laryngeal and pharyngeal function were rebuild by normal tissue preserved with lesions entirely removed.Twenty-seven cases were surgically treated with laryngeal functions preserved and eight cases total laryngectomy.The most of the cases received postoperative radiotherapy.Result:The overall 3 and 5-year survival rates were 45.7% and 28.6%,respectively.45.7% patients having laryngeal functions(voice, respiration and deglutition) completely restored and 31.4% partially restored(voice and deglutition). Among the died patients,nine cases died from cervical lymph node metastasis,ten cases died from local recurrence,twa cases died from lung metastasis,one cases died from cervical massive haemorrhage,twa cases died from hear disease and one died from ambiguous reason.Conclusion:The preservative surgery is feasible for the selected posterior hypopharyngeal wall cancer cases. Choosing and following what is optimum from multiple feasible surgical methods is a prerequisite for improving the quality of life of the cases.