梨状窝内侧壁癌的手术治疗

目的：探讨切除梨状窝内侧壁癌并保留喉功能手术的可行性及疗效。方法: 1990～2001年共手术治疗122例梨状窝内侧壁癌，其中87例行保留喉功能的梨状窝内侧壁癌切除术， T1、T2期患者行梨状窝切除术，将声门旁间隙组织一并切除，T3、T4期患者行梨状窝切除＋部分喉切除术，并根据肿瘤范围切除其他受累组织，以局部残留黏膜、胸大肌肌皮瓣、结肠上徙进行修复。35例未保留喉功能。术后均给予放射治疗。结果: 全部患者的3、5年生存率分别为67.2％（82/122）、45.1％（55/122），其中喉功能保留组3、5年生存率分别为71.3％（62/87）、48.3％（42/87），喉功能不保留组分别为57.1％（20/35）、37.1％（13/35）。喉功能保留组全部恢复呼吸、发音及吞咽保护者占71.3%（62/87）,部分恢复发音及吞咽保护占28.7%(25/87)。结论:在彻底切除肿瘤的前提下,对梨状窝内侧壁癌患者行喉功能保留手术是可行的。

Surgical treatment for medial wall pyriform sinus cancer

Objective：To study the surgical technique and results of surgical treatment for medial wall pyriform sinus cancer. Methods： A total of 122 patients with medial wall pyriform sinus cancer were surgically treated in our department between 1990 and 2001. Among them, 5 were in stage Ⅰ, 8 in stage Ⅱ, 37 in stage Ⅲ, and 72 in stage Ⅳ. Partial resection of the pyriform sinus and partial laryngectomy were performed on 87 cases. Epiglottis and sternohyoid myofascial flaps were used for laryngeal reconstruction. The remaining hypopharyngeal mucosa, pectoralis major musculocutaneous flap and colon interposition were used to cover the wound of hypopharynx and for artificial rebuilding. All patients received postoperative radiotherapy. Results：The overall 3 and 5 year survival rates were 67.2％（82/122）and 45.1％（55/122）, respectively. In the preservative surgery group, the 3 and 5 year survival rates were 71.3％（62/87） and 48.3％（42/87）, respectively, whereas those in the total laryngectomy group were 57.1％（20/35）and 37.1％（13/35）, respectively. Laryngeal functions were completely restored in 71.3%(62/87) and partially in 28.7% (25/87)of the total laryngectomy group. Conclusion： Although the medial wall pyriform sinus cancer tends to have a laryngeal invasion, preservative surgery should be practiced for the majority of patients after the lesions have been entirely removed.