喉癌治疗方法的选择和治疗失败原因分析

Choice of different therapeutic modalities and analysis of failure causes for laryngeal carcinoma treatment

目的： 探讨喉癌治疗方法的选择和分析喉癌治疗失败的原因。方法：总结本科 1989～ 1991年 3年间经根治的 151例喉癌病例，分单纯放疗、全喉切除术、部分喉切除术、挽救性手术 4个治疗组，分析各组的 3年和 5年生存率以及各组的失败原因。结果：单纯放疗组、全喉切除组、部分喉切除组、挽救性手术组的 3年和 5年生存率，分别为 45.9％ ,66.7％ ,94.4％ ,88.9％和 24.3％ ,56.5％ ,86.1％ ,66.7％，各组间差异有显著性；在晚期（Ⅲ＋Ⅳ期）病例中， 3年和 5年生存率分别为 27.3％ ,65.2％ ,87.5％ ,75.0％ 和 9.1％ ,54.5％ ,62.5％ ,50.0％，组间有显著性差异；在早期（Ⅰ＋Ⅱ期）病例中，单纯放疗组、部分喉切除组、挽救性手术组的 3年 和 5年生存率分别为 73.3％ ,96.4％ ,100.0％和 46.7％ ,92.6％ ,80.0％ ,各组间有显著性差异。各组治疗失败的原因均以原发灶复发为主。结论：喉癌的治疗以手术疗效最好；原发灶复发是喉癌治疗失败的主要原因。

Objective： The current study was designed to investigate the choice of different treatment modalities and analyze the causes of treatment failure. Methods： 151 cases of laryngeal cancer from 1989 to 1991 treated in our department were reviewed. The treatment modalities were classified into four groups： simple radiotherapy, total laryngectomy, partial laryngectomy, and salvage surgery for the fail after radical radiotherapy.The 3- year and 5- year survival rate,and their treatment failure was analyzed.Results： The 3- year and 5- year survival rates of the four groups including simple radiotherapy,total laryngectomy, partial laryngectomy and salvage surgery were 45.9％ , 66.7％ , 94.4％ , 88.9％ and 24.3％ , 56.5％ , 86.1％ , 66.7％ , respectively. There was significant difference between each group. The 3- year and 5- year survival rate among the four groups in advanced stage(StageⅢ andⅣ ) were 27.3％ , 65.2％ , 87.5％ , 75.0％ and 9.1％ , 54.5％ , 62.5％ , 50.0％ , respectively; and in StageⅠ andⅡ among simple radiotherapy, partial laryngectomy and salvage surgery groups were 73.3％ , 96.4％ , 100.0％ and 46.7％ , 92.6％ , 80.0％ , respectively. The differences were all significant. Tumor relapse was the main factor causing treatment failure in all groups. Conclusion： Surgery is the most effective way to treat laryngeal cancer and treatment failure can be mainly ascribed to tumor relapse.