喉部分切除术术中冰冻切片对预后评估的意义

The significance of intraoperative frozen section for prognosis evaluation of laryngeal carcinoma in partial laryngectomy

目的初步探讨术中冰冻切片对喉部分切除术手术范围的指导价值以及阳性切缘对预后的影响。方法以回顾性分析的方法,查阅我院自1996年1月～2001年12月行喉部分切除术病例中具有术中冰冻切片或有明确切缘距离记录的77例资料,将肉眼切缘距离、术中冰冻切片与术后病检切缘情况以及术后喉癌复发率和患者生存率评价加以分析。结果肉眼切缘0.5cm以内是否行术中冰冻切片对术后病理检查切缘的阳性率影响有统计学意义(P<0.05);肉眼切缘0.5cm以外是否行冰冻切片对术后病检切缘的阳性率影响无统计学意义(P>0.05)。是否行术中冰冻切片对患者术后喉癌复发率(包括局部复发与远处转移)影响有统计学意义(P<0.05)。术中冰冻切片组与单纯肉眼观察组生存曲线差异有显著性:行logRank统计,Kaplan-Meier法值=7.812,P=0.005<0.05,5年累积生存率分别为78.9%与66.7%。冰冻切片组与单纯肉眼观察组的平均生存时间分别为(102.336±4.606)个月与(77.782±4.362)个月。结论对于肉眼切缘<0.5cm的喉部分切除术,术中行冰冻切片能降低喉癌复发率(包括局部复发与远处转移),提高患者生存时间,应常规行术中冰冻切片。

OBJECTIVE To investigate the frozen section and surgical margin predicting the prognosis of laryngeal carcinoma after partial laryngectomy and decides the circumscription of surgical margin because of the balance between the function of the larynx and the recurrence rate of cancer. METHODS 77 cases of laryngocarcinoma were reviewed in this retrospective study. All of the laryngocarcinoma patients were treated in our hospital during 1996.1-2001.12 frozen section, surgical margin, and pathological section were compared to the recurrence rate of cancer and the survival rate of patients.RESULTS To those Partial laryngectomy whose surgical margin are larger than 0.5 cm, whether carrying out the frozen section is not significant. But to those Partial laryngectomy whose surgical margin are smaller than 0.5 cm, we should carry out the surgical margin to decrease the positive rate of the pathological section. Recurrent rate of the negative group is lower than the positive group （P〈0.05） . Carrying out the frozen section can decease the recurrent rate of the laryngocancimoma and improve the survival rate of patients. Acorrding to the log Rank statistics=7.812 （P=0.005〈0.05） , five years survival and mean survival time of the frozen section group is 78.9% and 102.336±4.606 months; while data of the macroscopic observation group is 66.7% and 77.782±4.362 months. CONCLUSION Carrying out the frozen section can decrease the recurrent rate of the laryngocancimoma and improve the survival rate of patients.