根治性放射治疗后口咽癌手术治疗的回顾性分析

A retrospective analysis of oropharyngeal cancer treated by surgical management after radical radiation

目的探讨口咽癌经根治性放射治疗后的手术方法和手术指征。方法采用同期口咽癌病例对照研究,回顾性分析本组32例经6000Gy术前根治性放射治疗后患者的一般资料、手术方式、并发症及相关因素,统计学处理采用SAS8.0统计软件,计数资料采用卡方检验,P<0.05有显著性差异。结果本组32例患者的根治性放射治疗后的有效率为100%,在手术时间、术中出血量等方面并无增加(P>0.05),但术后前3d的平均负压引流量、伤口并发症较对照组明显增加(P<0.05),不同的手术方式在放疗组中其术后并发症有显著性差异,而在对照组中,手术方式对术后并发症无影响。结论根治性放射治疗对各期口咽癌是有效的;根治性放射治疗后的手术治疗的并发症相对较多,手术方式宜采用以下颌骨切除术加口内切口直接缝合的根治性手术,而不宜采用邻位或血管化皮瓣整复的创伤较大的复杂手术。严格掌握根治性放疗后的手术指征,术前放疗的综合治疗方案要周密。

Objective To study the surgical management,attention and surgical indications of oropharyngeal cancer after radical radiation.Methods A retrospectively research on a total of 32 patients with oropharyngeal cancer who received preoperative 6000cGy radiation therapy, was carried out. The type of surgical management and other parameters such as lasted surgical time, postoperative complications, bleeding amount during the operation and draining amount in the three days after the operation were analyzed statistically and the results were analyzed by χ 2 analysis in the groups (treated group and controlled group).Results The effectual rate of radical radiation before operation was 100% in the 32 patients. There was significant difference in the aspect of incision complications, draining amount in the three days after the operation except lasted surgical time, bleeding amount during the operation (P<0.05) between treated group and controlled group. Different type of surgical management caused different complications in the treated group (P<0.05) and caused no difference in the controlled group (P>0.05).Conclusion Radical radiation therapy is effective to the patients suffered from oropharyngeal cancer. Surgical management caused more complications, and we should select much more conserved surgical management after radical radiation, the surgical indications after radical radiation are recurrences of oropharyngeal cancer and no cured condition. Moreover, consultation with radiation department is of great importance.