侵犯食管上端的下咽癌治疗效果分析

Surgical Management of Hypopharyngeal Carcinoma with Proximal Esophagus Involvement

目的探讨下咽癌侵犯食管上端的治疗效果。方法回顾性分析1998年1月至2003年1月间17例侵犯食管上段的下咽癌病例。根治性放疗8例,手术加放疗9例,其中2例行下咽、全喉、全食管切除,咽胃吻合术,7例行下咽、全喉、食管上端切除、舌瓣和胸大肌肌皮瓣重建下咽及颈段食管;8例伴行双侧颈清扫术,1例同侧颈清扫术。全部病例术后随访。结果 9例手术加放疗患者8例均能经口进食,日常生活自理;1例吻合口狭窄;5例已死亡,中位生存期29个月;8例单纯根治性放疗者6例已死亡,中位生存期13个月。结论下咽、全喉、全食管切除,胃咽吻合术或下咽、全喉、食管上端切除、舌辨和胸大肌肌皮瓣重建下咽及上段食管加术后放疗,治疗下咽癌侵犯上端食管的方法可行,预后较单纯放疗好,应采用积极的治疗方法,但生活质量欠满意。

Purpose To evaluate the clinical value of laryngo-pharyngectomy and partial or totall-esophagectomy and two repairing ways for hypoparyngeal carcinoma violating proximal esophagus.Methods Seventeen patients were reviewed during 1998 and 2003,8 cases with radiation only,9 cases with operation and radiation.Follow-up were made in all patients. Results Postoperative complications included anastomotic stricture in one case.Functional outcomes in 8 eases including daily activities and swallowing function were acceptable.The mean survival time was from 9 to 42 months with a median survival time of 31 months in 9 cases with operation and radiation.The mean survival time was from 4 to 20 months with a median survival time of 14 months in 8 cases with radiation only.Conclusion Comparison of radiation only,the operation with radiation was more effective for hypopharyngeal carcinoma violating proximal esophagus.