摘要
目的 :探讨晚期下咽癌手术治疗中如何保留喉功能 ,保留喉功能可能发生的问题及其处理。方法 :在下咽癌根治性切除的手术中 ,根据喉受累及的情况 ,施行喉部分切除或喉全切除发音重建术。同时根据临床检查结果及术前病理诊断决定行单侧或双侧颈廓清术。为防止术后并发症及发音重建失败 ,笔者对手术方法进行探讨。下咽及颈段食管缺损的修复 ,均采用硅橡胶管重建的方法。结果 :晚期下咽癌手术共 2 7例 ,长期保留喉发音功能者 2 1例 ,喉发音功能恢复率为 77.8%。术后并发症 ,咽瘘发生率为 2 2 .2 % (6 / 2 7) ,误吸发生率为 11.1% (3/ 2 7)。局部癌复发 4例 (14 .8% )。 3年生存率为 4 8.1% ,5年生存率为 30 %。主要死亡原因为颈淋巴结转移和局部复发。结论 :晚期下咽癌手术 ,可在彻底切除肿瘤的基础上 ,根据喉受累及情况 ,施行保留喉功能的手术 ,以利提高病人的生存质量。对喉部分切除术者 ,应严格掌握适应证 ,手术方法要注意预防术后并发症的发生。因颈淋巴结癌转移与预后关系较大 ,所以临床诊断 N0 者 ,也要行患侧颈淋巴结清扫术。
Objective: To explore how to preserve the laryngeal function in the surgical treatment of advanced hypopharyngeal carcinoma,and how to avoid and deal with the complications.Methods:Twenty\|seven patients with advanced hypopharyngeal carcinoma were treated by surgery from May 1993 to December 1998 in our department.There were 22 males and 5 females,ranging in age from 46 to 75 years old.In the hypopharyngectomy,after partial laryngectomy or total laryngectomy,the vocal reconstruction was performed according to the invaded extent of the larynx,and unitary or bilateral cervical lymph node dissection was also performed.The defects of hypopharynx and cervical esophagus were reconstructed by the insertion of silicon rubber tube.Results:The rate of preservation of laryngeal function was 77 8%(21/27),pharyngeal fistula 11 1%(3/27)and the local recurrent rate of cancer was 14 8%(4/27).The survival rates of 3\|year and 5 year were 48 1%(13/27) and 30 0%(6/20) respectively. The main causes of death were cervical lymph node metastases and local recurrence. Conclusion: The surgery treatment of advanced hypopharyngeal carcinoma by the procedure of preserving the laryngeal function according to the invaded extent of the larynx base of radical hypopharyngectomy should be improvement of the patient life quality.The selection of indications of partial laryngectomy was important for the successful rate.Because of the close relationship between cervical lymph node metastases and prognosis,the unitary neck dissection should be done in cN 0 cases.
出处
《耳鼻咽喉（头颈外科）》
2002年第4期217-219,共3页
Chinese Arch Otolaryngology-Head Neck Surg
