下咽癌的手术治疗及预后分析

Analysis of hypopharyngeal carcinoma operation treatment and prognosis

目的:探讨下咽癌的手术疗效及影响预后的因素。方法:回顾性收集本院1990年1月份-2009年12月份行手术治疗的249例下咽鳞癌患者的临床资料。其中男236例,女13例,男女比例为18∶1;年龄40~84岁,中位数59岁;梨状窝型217例,下咽后壁型27例,环后型5例;全组患者病理诊断均为鳞状细胞癌;将全组资料按时间分为两组,即1999年12月31日之前行手术治疗的为前10年组,2000年1月1日之后的为后10年组,两组分别按照UICC1997TNM分级分期标准,Ⅰ期2例,Ⅱ期22例,Ⅲ期50例,Ⅳ期175例。44例作了喉功能保留手术,205例未保留喉功能。所有患者均行颈淋巴清扫术,其中双侧颈清扫术143例,单侧颈清扫术106例。患者术后均给予放射治疗,剂量50~60Gy。累积生存率计算采用Kaplan-Meier法,生存率差异比较采用Log-rank检验。结果:随访率91.4%,总的3年生存率为54.6%,5年生存率为36.5%;前10年的3年、5年生存率为47.6%、33.5%,后10年的3年、5年生存率为56.8%、41.5%;喉功能保留组的3年、5年生存率分别为59.1%、45.5%,喉功能未保留组3年、5年生存率分别为50.2%、24.9%;无颈淋巴结转移组的3年、5年生存率分别为74.0%和56.0%,有淋巴结转移组的3年、5年生存率分别为46.2%、21.6%。前10年咽瘘的发生率为17.8%,后10年咽瘘的发生率为5.8%。结论:保留喉功能的下咽癌手术是可行的,根据具体情况合理选用咽喉功能重建方法是提高患者生存质量的重要保证。颈部淋巴结转移率较高,有无颈淋巴结转移直接影响预后,初诊时对其进行准确评估并行及时有效的颈淋巴结清扫可能有助于改善预后。

Objective：To study the surgical efficacy of hypopharyngeal cancer and the factors affecting the prognosis.Methods：A retrospective review of 249（ 236 males,13 females,ages ranging from 40 to 84 years,median is 59years） cases with hypopharyngeal cancer that were treated with surgical treatment from 1990 to 2009 were accomplished.All the tumors originated from the pyriform sinus（ 217）,posterior pharyngeal wall（ 27）,postcricoid area（ 5）.The all pathological type is squamous cell carcinoma.According to UICC 1997 criteria stageⅠwas 2 cases,Ⅱfor 22,Ⅲ for 50,Ⅳ for 175.Forty-four cases were surgically treated with laryngeal functions preserved and two hundred and five cases without laryngeal functions preserved.All the patients received modified neck dissection,including both unilateral（ 106 patients） and bilateral（ 143 patients）.All patients received radiotherapy postoperatively（ 50 ~60Gy）.Cumulative survival rate is calculated with Kaplan-Meier method,survival differences comparing with the Log-rank test.Results：Follow-up rate was 91.4%.The 3-year and 5-year overall survival rates were 54.6%and 36.5% respectively.The 3-year and 5-year survival rate of the first 10 years were 47.6% and 33.5%,56.8% and41.5% for later 10 years.Laryngeal function keep group＇s 3-year and 5-year survival rate were 59.1%,45.5%and 50.2%,24.9% for no reserved group.No transfer analysis group for 3-year and 5-year survival rate were 74.0%and 56.0%,3-year,5-year of survival rate of lymph node metastasis group respectively were 46.2%,21.6%.The incidence of pharyngeal fistula was 17.8% during the previous decade,after 10 years the incidence of pharyngeal fistula was 5.8%.Conclusion：Retaining laryngeal function of stomach cancer surgery is feasible.According to specific circumstances the throat function reconstruction method＇s reasonable choice is an important guarantee to improve the quality of survival.Neck lymph node metastasis rate is higher.The presence of metastasis directly influences the prognosis,and key carries on the accurate assessment may help to improve the prognosis.