保留咽喉功能的下咽癌手术分析

Clinical analysis of laryngeal function-preserving surgery in patients with hypopharyngeal carcinoma

目的下咽癌发病率低但病死率高,且位置隐蔽极易误诊,手术后易产生淋巴结转移。本文旨在分析下咽癌患者施行保留喉功能手术的临床疗效,并比较放射治疗对保留喉功能手术临床效果的影响。方法 120例下咽恶性肿瘤患者,其中38例患者进行不保留喉功能手术(阴性对照组);82例采用保留喉功能手术,其中39例保留喉功能患者采用单纯手术治疗(阳性对照组),其余43例患者在手术后给予放射治疗(综合治疗组)。结果保留喉功能手术有57.3%(n=47)的患者喉功能得以全部恢复,且其中的综合治疗组(n=43,90.7%)也较阳性对照组的临床总有效率(n=39,69.2%)明显升高,差异具有统计学意义(χ2=6.001,P<0.05)。所有患者的3年及5年后生存率以下咽上区癌手术患者生存率最高分别为72.1%(n=5)和58.2%(n=4),而且喉功能保留与不保留患者的术后并发症和吞咽成功率经比较差异均无统计学意义(P>0.05)。结论保留喉功能的下咽癌手术是可行的,临床疗效较好且喉功能恢复率较高,而保留喉功能的下咽癌手术同时配合放射治疗则有助于进一步提高临床疗效,降低病死率且可避免发生转移,故建议临床上加以推广应用。

Objective Despite the low incidence,hypopharyngeal cancer still has high mortality. Patients are often misdiagnosed because of its position. The lymph node metastasis after radical surgery is common. The aim of this paper is to evaluate the clinical effects of laryngeal function-preserving surgery in patients with hypopharyngeal carcinoma and discuss the role of radiotherapy after the operation. Methods 120 patients with malignant neoplasm of hypopharynx were enrolled in this study. The laryngopharyngeal resection was performed in 38 patients （ negative control group）, while the laryngeal function-preserving surgery was performed in 82 patients ,in which 43 cases were with postoperative radiotherapy（ comprehensive treatment group） and 39 cases without postoperative radiotherapy（ positive control group）. Results The laryngeal function were fully recovered in 47 patients （57.3 % ） with laryngeal function-preserving surgery. The total effective rate was 90.7% in the comprehensive treatment group and 69.2% in the positive control group, the difference was statistically significant（ X^2 = 6. 001, P 〈 0.05 ）. The patients with upper hypopharyngeal cancers had a highest three-year survival rate （72. 1% ） and five-year survival rate （58.2%）. There were no significant difference in the incidence of postoperative complications and success rate of swallowing between the patients with laryngeal function-preserving surgery and patients with laryngopharyngeal resection （ P 〉 0.05 ）. Conclusion The laryngeal function-preserving surgery is feasible in patients with hypopharyngeal carcinoma, with a better clinical effects and recovery of function. This procedure combined with radiation therapy can improve the clinical effects, reduce the mortality of patients and reduce the chance of metastasis, it is suggested popularization and application in clinical.