保留喉功能喉咽癌手术治疗的临床资料分析

Treatment and clinical analysis of larngeal function preserring surgery in hypophngeal carcinoma

目的:评价喉咽癌保留喉功能及不保留喉功能手术临床疗效和影响预后的因素。方法:回顾性分析1974-09-2006-07收治的93例喉咽癌临床治疗效果。其中梨状窝癌57例,环后癌20例,喉咽后壁癌16例。保留喉功能手术53例,不保留喉功能手术40例。对喉咽癌切除手术患者的手术效果、并发症、生存率、修复材料和方法等进行分析。结果:采用Kaplan-Meier法行生存分析,生存曲线显示总的3、5年生存率分别为69.9%和43.0%,保留喉功能组和未保留喉功能组的3年生存率分别为73.6%和67.5%,5年生存率分别为49.1%和32.5%,2组差异无统计学意义(χ2=2.566,P>0.05)。单因素分析显示生存率与T分期、术前颈淋巴结转移、病理分化程度有关(分别P<0.05、P<0.01、P<0.01)。Cox回归模型分析显示T分期、病理分化程度是否行手术治疗是影响患者预后的独立因素。保留喉功能与不保留喉功能在肿瘤发生部位、并发症、肿瘤残留、肿瘤复发等相关因素比较差异无统计学意义。结论:喉咽癌保留喉功能手术不影响生存率,保留喉功能喉咽癌手术是可行的,提高了喉咽癌患者的生存率及生存质量并取得较满意的治疗效果。

Objective：To evaluate the therapeutic effect and the prognosis of the laryngeal function preserving surgery （LFPS） and total laryngectomy in hypophngeal carcinoma. Method： Ninety-three cases of laryngopharynx carcinoma were retrospectively analyzed from September 1974 to September 2006. Among which 57 cases were primary pyriform sinus cancer,20 cases were postero-cricoid cancer and 16 cases were postero-pharyngeal wall cancer. 53 cases were treated by LFPS, and 40 cases were treated by total laryngectomy. The treatment effectiveness, complication, survival rate and repair materials were analysed. Result：Adopting Kaplan-Meier survival analysis, the 3-year survival rates were 69. 9%and 5 year survival rates were 43.0%. The 3-year survival rates of LFPS and Non-LFPS were 73.6% and 67.5%, and the 5-yenr survival rates of LFPS and Non-LFPS were 49.1% and 32. 5 %. There was no significant difference between the two groups（χ^2 = 2. 566, P〉0.05）. Single element analysis indicated survival rates concerned with T-stage（χ^2= 9. 764 ,P〈0.05）, neck lymphatic transfer（χ^2 = 10. 472, P〈 0.01） and the degree of pathological differentiation（χ^2 = 25. 894, P〈0.01）. Cox regression analysis suggested that T-stage,the degree of pathological dfferentiaton and wheather going through the surgical operation were the independent elemant of the patient＇s prognosis. There was no significant difference between LFPS and No-LFPS in the neoplasms location, complication, neoplasms residuum and neoplasms recurrence. Conclusion： LFPS did not affect the survival rates and LFPS was feasible. LFPS can increase the living quality of laryngopharynx careinoma patients.