环后癌的手术治疗

Surgical treatment of postcricoid carcinoma

目的探讨环后癌手术治疗的相关技术方法。方法对21例环后癌患者进行手术治疗,其中T3N0M05例,T3N1M01例,T3N2M02例,T4N0M07例,T4N1M04例,T4N2M01例,T4N3M01例。在彻底切除肿瘤的前提下,保留可利用的正常组织进行咽喉功能重建。共行保留喉功能手术10例,不保留喉功能手术11例,同时行单侧颈清扫术8例,双侧颈清扫术3例,术后行辅助放疗。结果随访时间60～276个月,平均96个月。全组患者3年生存率61.9%(13/21),5年生存率52.4%(11/21)。随访期间死于颈淋巴结转移4例,肿瘤局部复发3例,心肺功能衰竭1例,原因不明2例。喉功能保留病例仅恢复了发音和吞咽保护功能。术后出现咽瘘5例,下咽狭窄3例,严重误吸1例。结论在彻底切除肿瘤的前提下谨慎选择环后癌手术方法,利用保留下来的正常喉组织进行喉功能重建,从而恢复喉的部分功能是可行的。患者可获得较好的生存率和生存质量。

Objective To explore the surgical techniques in surgical treatment of postcricoid carcinoma. Methods Twenty-one cases with postcricoid carcinoma were treated surgically.The TNM stage were as follows:T3N0M0 5 cases,T3N1M0 1 case,T3N2M0 2 cases,T4N0M0 7 cases,T4N1M0 4 cases,T4N2M0 1 case,T4N3M0 1 case. The laryngeal and pharyngeal functions were rebuilt by the remaining tissue when the lesions entirely removed. Ten cases were surgically treated with laryngeal functions preserved and 11 cases with total laryngectomy. Eight cases were received unilateral neck dissection, and 3 cases were received bilateral neck dissection.All the cases received postoperative radiotherapy. Results The follow-up interval varied from 60 to 276 months with average interval 96 months. Four cases died of cervical metastasis,3 died of local recurrence,1 died of cardiopulmonary failure,2 died of unknown reasons.The overall 3 and 5 year survival rates were 61.9%(13/21) and 52.4%(11/21),respectively. Among 10 cases having laryngeal functions partially restored(voice and deglutition), the postoperative complications included 5 cases of pharyngeal fistula,3 hypopharyngeal stenosis and 1 severe aspiration. Conclusions The preservative surgery is feasible for the selected cases with postcricoid carcinoma.The laryngeal function can be partially restored with lesions entirely removed. The patients can gain satisfied survival rate and quality of life.