老龄喉癌患者手术治疗远期疗效分析

The therapeutic outcomes of surgery on senile patients with laryngeal carcinoma

目的:探讨老龄喉癌患者手术疗效及预后因素。方法:≥65岁的喉癌患者110例中,行喉部分切除术62例,喉全切除环咽吻合术(Arslan术)8例,喉全切除术40例。53例联合放疗及化疗。结果:4例失访,5、10年生存率分别为66.6%和44.2%;5、10年无瘤生存率分别为57.0%和38.4%,中位生存期84个月。拔管率87.1%。单因素分析组织学分级、治疗模式、淋巴结转移、原发部位不同组间生存分布的差异具有统计学意义(P<0.01);肿瘤分期、手术方式、复发、性别不同组间生存分布的差异具有统计学意义(P<0.05)。多因素分析组织学分级及治疗模式对本组患者生存率影响较大,分化程度低及综合治疗者生存期短。结论:喉功能保全性手术是治疗老龄喉癌患者的有效方法;综合治疗者预后差,不适用于切缘阴性者。

Objective：To investigate the therapeutic outcomes of laryngectomy and prognostic factors in senile patients with laryngeal carcinoma. Method： A retrospective study of long-term therapeutic outcomes was performed on 110 patients with laryngeal carcinoma over 65. treated mainly by surgery, from 1990 to 2005. Different kinds of operations were as follows： cordectomy（1 case）or stripping （2 cases） by suspended laryngoscope, laryngofissure （4 eases）, vertical partial laryngectomy without tracheotomy （8 cases）, vertical partial laryngectomy （8eases） , extended vertical partial laryngectomy（1 case）, horizontal laryngectomy （4 cases） , subtotal laryngectomy（4 eases）, crieohyoidoepiglottopexy （30 cases）, Arslan＇s procedure （8 cases） , and total laryngectomy （40 cases）. Forty-eight patients were treated with preoperative or postoperative radiotherapy, and five patients were treated with induction chemotherapy followed by radiotherapy. Result：There were four missing cases among all 110 cases. The 5- and 10-year overall survival rate were 66.6 % and 44.2 % . respectively. The 5-and 10-year diseasesfree survival rate were 57.0% and 38.4 %, respectively. The median survival was 84 months. Decannulation rate was 87.1% （54/62）. Well-differentiation, surgery alone, node-negative, glottic carcinoma, early stage, partial laryngectomy, non-recurrence and male were favorable prognostic factors with univariate analysis （ P 〈0.05）. Well-differentiation and surgery without combined therapy were also favorable prognostic factors with multivariate analysis. Conclusion：Conservation laryngectomy was an efficient method to treat senile patients with laryngeal carcinoma. Combined therapy should better not be adopted to patients with negative surgical margins.