手术加放射治疗与单纯喉部分切除术治疗喉癌的疗效比较

Partial laryngectomy plus radiotherapy versus partial laryngectomy alone for laryngeal carcinoma

目的 探讨手术加放射治疗能否比单纯部分喉手术提高疗效。方法 1 71例喉癌随机分为单纯手术、手术加术后放射治疗 (剂量 5 1～ 70Gy)和放射治疗加手术 (剂量 40～ 5 0Gy) 3组 ,前瞻性观察各组的治疗效果。术式包括 :声带切除术、垂直半喉切除术、水平半喉切除术、次全喉切除术。结果 单纯手术组 (5 6例 )、手术加术后放射治疗组 (6 5例 )和术前放射治疗加手术组 (5 0例 )的 5年生存率分别为 85 7% (42 / 49)、80 7% (46 / 5 7)和 79 5 % (35 / 44 ) ,经 χ2 检验 ,差异无显著性 (χ2 =0 70 3,P =0 70 4)。三组总的 5年生存率为 82 0 % (1 2 3/ 1 5 0 )。临床I、II、III、IV期的 5年生存率分别为91 9%、85 1 %、6 8 4 %和 0 %。经 χ2 检验 (χ2 =1 2 2 48,P =0 0 0 7) ,差异有显著性。全组 1 71例 (除 3例次全喉切除术病例外 )均获得良好或较好的发音效果。结论 手术联合术前放射治疗或术后放射治疗均未能提高 5年生存率 ;部分喉切除术的各种术式除次全喉切除术外 ,所获得的发音功能均较满意。

Objective To investigate the effect of radiotherapy in the combined treatment of laryngeal cancer with partial laryngectomy Methods One hundred and seventy one cases of laryngeal cancer were randomly separated into three groups of partial laryngectomy, partial laryngectomy with preoperative radiotherapy(dose 40 50Gy) and partial laryngectomy with postoperative radiotherapy(dose 51 70 Gy) The surgical procedures included cordectomy, vertical partial laryngectomy, horizontal partial laryngectomy and near total laryngectomy Results The overall 5 year survival rate was 82%(123/150) The 5 year survival rates for surgery alone group(56 cases), surgery with preoperative radiotherapy group(65 cases) and surgery with postoperative radiotherapy group(50 cases) were 85 7%, 80 7% and 79 5% respectively There was no significant difference among the groups(χ 2=0 703, P =0 704) Analysis of survival rates revealed a significant difference among the different stages(χ 2=12 248, P =0 007) All 171 cases except 3 that had near total laryngectomy achieved satisfactory phonation Conclusion Neither preoperative radiotherapy nor postoperative radiotherapy can improve the 5 year survival rate of laryngeal cancer with partial laryngectomy All patients with partial laryngectomy got satisfactory phonation