保留喉功能喉咽癌的手术切除与修复

目的 评价喉咽癌保留喉功能手术临床治疗效果和影响预后因素.方法 回顾性分析1974年9月至2003年7月收治的45例喉咽癌保留喉功能手术临床治疗效果.其中梨状窝癌23例,环后癌13例,喉咽后壁癌9例.术前放疗2例,放疗量40～50 Gy;术后放疗32例,放疗剂量60～70 Gy.分析影响患者生存率的危险因素.结果 45例保留喉功能术后发音清晰者88.9%,发音轻度含混者占11.1%;23例拔除气管套管,拔管率51.1%,全部能进普食.出现术后并发症19例(42.2%);术后颈部淋巴结转移20例,占44.4%.Kaplan-Meier法统计全组患者5年生存率为53.3%.T1+T2组和T3+T4组患者术后5年生存率分别为66.7%和43.3%;cN0和cN1、cN2组生存率分别为65.2%和46.7%、28.6%;病理分化程度高、中和低组生存率分别为62.3%、42.1%和30.8%.单因素分析生存率与术前有无颈淋巴转移及病理分化程度有关(x2值为5.297和11.556,P值为0.021和0.003).Cox回归多因素分析显示,术前有无颈淋巴转移和病理分化程度是影响预后的独立危险因素(x2值为4.365和4.600,P值为0.041和0.032,OR值1.151和0.610).结论 喉咽癌保留喉功能手术为T1、T2患者的最佳术式,部分T3、T4晚期喉咽癌也可以采用保留喉功能手术.正确选择颈清扫的方法,有助于提高喉咽癌保留喉功能手术的生存率.

Larngeal function preserving surgery in hypopharyngeal carcinoma

Objective To evaluate the preservation of laryngeal function hypopharyngeal cancer surgery clinical effectiveness and impact of prognostic factors. Methods A retrospective analysis in September 1974 - July 2003 treated 45 cases of hypopharyngeal cancer surgery retain the clinical treatment of laryngeal function effect. Among them there were 23 cases of original pyriform sinus cancer,13 cases of post cricoid cancer and 9 cases of postero pharyngeal wall cancer. Two cases of preoperative radiotherapy, radiotherapy volume of 40 -50 Gy; after 32 cases of radiotherapy, radiotherapy dose of 60 -70 Gy. Analysis of impact on survival in patients with risk factors. Results Forty five cases of preservation of laryngeal function after 88. 9% who articulate pronunciation ambiguities were mild 11.1% ; 23 cases of tracheostomy tube removal, decannulation rate was 51.1%, all can eat into the cape. Nineteen cases of post-operative complications (42. 2% ) ; after 20 cases of cervical lymph node metastasis, accounting for 44. 4%. Statistics Kaplan-Meier method in patients with the whole group 5-year survival rate was 53.3%. T1 + 'T2 and T3 + T4 patients after 5-year survival rates were 66.7% and 43.3% ; cN0 and cN1, cN2 group survival rates were 65. 2% and 46. 7%, 28. 6% ; pathological differentiation of high, medium and low-group survival rates were 62. 3%, 42. 1% and 30. 8%. Single-factor analysis of survival and whether pre-operative cervical lymph node metastasis and the degree of pathological differentiation (x2 value of 5. 297 and 11. 556, P value of 0. 021 and 0. 003). Multivariate Cox regression analysis showed that the availability of pre-operative cervical lymph node metastasis and pathological effects of the degree of differentiation is an independent risk factor for prognosis (x2 value of 4. 365 and 4.600, P value of 0.041 and 0.032, OR value of 1. 151 and 0.610). Conclusions Preservation of laryngeal function hypopharyngeal cancer surgery for T1, T2 patients with the best surgical procedures, some of T3, T4 advanced hypopharyngeal cancer can also be used to retain the operation of laryngeal function; and preservation of laryngeal function can not affect the prognosis of patients with.