摘要
目的总结下咽癌手术切除、咽喉功能重建的临床经验，分析综合治疗疗效。方法回顾性分析1999--2005年山东大学齐鲁医院耳鼻咽喉科手术治疗的352例下咽癌患者的临床资料，其中男321例，女31例；年龄26—82岁，中位数58岁；梨状窝癌272例，下咽后壁癌61例，环后癌19例；按照UICC2002TNM分级分期标准，Ⅰ期3例，Ⅱ期31例，Ⅲ期134例，Ⅳ期184例。241例作了喉功能保留手术，111例未保留喉功能，喉功能保留率68．5％，梨状窝癌的喉功能保留率75．7％（206／272）。所有患者均行颈淋巴清扫术，其中双侧颈清扫术105例，单侧颈清扫术247例。保留喉功能组采用直接缝合137例，胸大肌肌皮瓣修复62例，裂层皮片2例，裂层皮片＋胸大肌皮瓣5例，胃代下咽食管12例，结肠代下咽食管23例；不保留喉功能组采用直接缝合17例，喉气管黏膜瓣修复下咽54例，胸大肌肌皮瓣修复7例，胸大肌肌皮瓣＋喉气管瓣8例，累及食管者应用胃代下咽食管22例，结肠代下咽食管3例。术后均给予放射治疗，剂量55～75Gy。生存率统计采用直接法，失访按死亡计。结果随访率96．6％（340／352）。全部患者3年、5年生存率分别为65．1％（229／352）、53．6％（142／265）；各期5年生存率分别为Ⅰ期3／3，Ⅱ期80．6％（25／31），Ⅲ期65．O％（67／103），Ⅳ期36．7％（47／128）。241例喉功能保留组，喉功能（呼吸、发音及吞咽保护）全恢复169例（70．1％），发音及吞咽保护恢复72例（29．9％），3年、5年生存率分别为68．0％（164／241）、59．7％（114／191）；喉功能未保留组3年、5年生存率分别为58．6％（65／111）、37．8％（28／74）。病理结果均为鳞状细胞癌，高、中、低分化分别为84例、163例、105例；淋巴转移为239侧。结论下咽癌以综合治疗为主，在安全彻底切除肿瘤的前提下，保留喉的正常
Objective To review the experience of different surgical construction methods and comprehensive treatments for hypopharyngeal cancer. Methods Three hundred and fifty-two cases （ According to UICC 2002 criteria, stage Ⅰ , 3 ;Ⅱ , 31 ; Ⅲ, 134 ; Ⅳ, 184 ） with hypopharyngeal cancer were retrospectively reviewed from 1999 to 2005 in the Department of Otorhinolaryngology of Qilu Hospital of Shandong University, including 321 males and 31 females. The median age was 58 years old, ranged from 26 to 82 years old. All the tumors originated from the pyriform sinus （272）, posterior pharyngealwall（61 ）, postericoid area（19）. There were no distantmetastasis. Two hundred and fourty-one cases were surgically treated with laryngeal functions preserved and 111 cases without laryngeal functions preserved. All the patients received modified neck dissection, including both unilateral （247 patients） and bilateral （105 patients）. Pharyngoesophageal defect reconstruction methods in cases with laryngeal functions preserved were： direct suture in 137, pectoralis major musculoeutaneous flap in 62, split graft in 2, pectoralis major musculoentaneous flap combined with the split graft in 5, stomach pulling-up in 12, colon interposition in 23 patients. While in cases without laryngeal functions preserved the methods includes： direct sutare in 54, laryngotracheal flap in 54 patients, pectoralis major musculocutaneous flap in 7, laryngotraeheal flap combined with pectoralis major musculocutaneous flap in 8, stomach pulling-up in 22, colon interposition in 3 patients. All patients received radiotherapy postoperatively （dose 55 -75 Gy）. Results The overall 3 and 5 year survival rates were 65. 1% （229/352） and 53.6% （ 142/265）, respectively. For stage Ⅰ , the 5 year survival rate was 3/3, stageⅡ, 80. 6% （25/31）, stage Ⅲ, 65.0% （67/103）, stageⅣ, 36. 7% （47/128）. The 3 and 5 year survival rates in functionally preserved group were 68.0% （164/241）and 59. 7% （114/191） , respect
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2009年第9期710-715,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
下咽肿瘤
喉切除术
咽切除术
综合疗法
癌
鳞状细胞
Hypopharyngeal neoplasms
Laryngectomy
Pharyngectomy
Combined modality therapy
Carcinoma, squamous cell
