晚期扁桃体癌放疗后复发的手术治疗

Surgical treatment for advanced tonsillar cancer of recurrence after radiotherapy

目的 探讨晚期扁桃体癌放疗后复发的手术治疗方法。方法 对我科 1 993年 6月～ 2 0 0 0年 8月诊治的 2 3例晚期扁桃体癌根治性放疗后复发的病例 ,采取颈 下颌骨正中切开外旋入路切除扁桃体复发肿瘤 ,带蒂的胸大肌皮瓣I期修复缺损 ,并行颈淋巴结清扫术。结果 全部病例随访 3～ 1 0年 ,3年生存率 2 6 .1 %(6 / 2 3) ,3年无瘤生存率 1 7.4 %(4/ 2 3) ,3年内局部再复发 1 9例 ,其中死亡 1 6例 ,失访 1例。皮瓣下、颈部局部感染 5例 ,皮瓣远端部分坏死 2例 ,呼吸困难 1例 ,误咽 2例。结论 晚期扁桃体癌放疗后复发的预后差。对适合病例作下颌骨正中切开外旋入路切除肿瘤 ,带蒂胸大肌皮瓣I期修复缺损 ,并行颈淋巴结清扫术 ,可延长病人生命 ,减少痛苦 ,提高生存质量。

Objective To evaluate the treatment for the patients with advanced-stage tonsillar cancer of recurrence after radiotherapy. Methods A retrospective review for 23 patients with advanced-stage tonsillar cancer of recurrence after radiotherapy was conducted. All of the cases were referred to Cancer Hospital of Guangzhou from 1993 to 2000. The patients underwent resections combining mandibular ramus, neck dissection, and one-stage repair of the defect with pectoralis major myocutaneous flap. Results There was no postoperative death.10 patients had minor complications such as local infection, salivary leakage and so on. Following 3 to 10 years, 26.1% (6/23) cases survived for more than 3 years. Conclusions The overall prognosis of tonsillar recurrence after radiotherapy was awful and dismal. A proper surgical treatment in some cases of tonsillar recurrence would prolong the lifetime and improve the life quality of the patients.