喉癌治疗后复发的临床因素分析及治疗

Clinical analysis and treatment of recurrent laryngeal cancer

目的探讨喉癌治疗后复发的临床因素以及诊断与治疗。方法应用2χ检验以及logistic多因素回归分析方法分析114例喉癌的临床复发因素并分析其中23例复发喉癌的临床资料。结果 2χ检验统计结果显示,喉癌术后复发与原发肿瘤部位、分化程度以及T分期有关,与首次手术方式无关;Logestic多因素回归分析显示,切缘阳性是喉癌复发的高危因素。23例复发性喉癌中,喉癌局部复发13例,颈淋巴结转移7例,局部复发并颈淋巴结转移3例。治疗采取放疗、部分喉切除、(扩大)全喉切除及(或)颈廓清术。局部复发组随访5年13例中8例生存,3例死亡,2例失访;颈淋巴结转移组7例中4例生存,2例死亡,1例失访;局部复发并颈淋巴结转移3例,1例存活,1例死亡,1例失访。结论喉癌手术后复发与原发肿瘤部位、分化程度、T分期以及阳性切缘有关;喉癌术后定期随访有助于早期明确有无复发;对复发性喉癌的治疗仍以手术为主。

Objective To explore clinical factors and treatment of recurrent laryngeal cancer.Methods The clinical data of 23 recurrent laryngeal cancer cases were reviewed, while the recurrence factors of78 laryngeal cancers were analyzed by χ2-Test and Logistic Degression analysis.Result The recurrence of laryngeal cancer was related to location, the grading of pathology and the Tstage, but not method of operation. A positive incision margin was a risk factor for recurrence. A- mong 23 recurrent laryngeal cancer patients,there were 13 local recurrences, 7 cervical metastasis, and 3 local recurrences accompanied with cervical metastasis. Treatments consisted of radiation therapy, partial laryngectomy, total laryngectomy and radical neck dissection. In 13 cases with local recurrence, 8 patients survived, 3 patients died, and 2 patients were lost during the follow-up. In 7 cases with only cervical metastasis, 4 patient survived, 2 patients died, and 1 patients was lost during the follow-up. As for the other3 patients with both local recurrence and cervical metastasis,1 patient survived, 1 patient died, and 1 patient was lost.Conclusion Laryngeal cancer recurrence is associated with tumor location, grad- ing of pathology, Tstage and a positive incision margin. Regular follow-up is helpful to trace laryngeal cancer recurrence. Surgery is the effective treatment for recurrent laryngeal cancer.