局部晚期下咽癌的手术治疗及对患者生存质量的影响

The impact of surgical treatment on the life quality of patients with locally advanced hypopharyngeal carcinoma

目的探讨局部晚期下咽癌的手术治疗方法及对患者生存质量的影响。方法回顾性分析2017年1月1日至2019年12月31日于中国医学科学院肿瘤医院深圳医院行手术治疗的21例晚期下咽癌患者的临床资料,其中放化疗后复发3例,手术治疗后复发4例,手术+放化疗后复发3例,下咽癌合并食管癌3例,Ⅳ期下咽癌8例。3例行胃代食道修复,4例行游离空肠代食道修复,2例取大隐静脉移植代颈内动脉,1例人造血管代颈内动脉,5例行转移胸大肌皮瓣修复,2例行转移颏下岛状皮瓣修复。21例患者分别于术前及术后3个月采用欧洲癌症研究与治疗组织的生存质量头颈肿瘤专用量表(EORTC QLQ-H&N35)进行评分,比较患者术后生存质量的变化。结果21例患者术前生存质量评分为(56.86±7.95)分,术后3个月为(50.93±7.91)分,术后生存质量明显提高(P<0.05)。患者术后生存质量的提高主要是头颈部位疼痛、吞咽功能、饮食情况、服用止痛药及留置鼻饲管5个方面的改善,术前评分分别为(7.58±1.56)分、(8.46±1.63)分、(7.94±0.43)分、(1.76±0.12)分和(1.86±0.28)分,术后3个月评分分别为(5.02±1.23)分、(6.28±1.58)分、(6.34±0.36)分、(1.12±0.08)分和(1.24±0.18)分,差异均有统计学意义(均P<0.05)。结论局部晚期下咽癌灵活选用皮瓣修复仍可行手术治疗,手术可以提高患者的生存质量。

Objective To explore the impact of surgical treatment on the life quality of patients with locally advanced hypopharyngeal carcinoma.Methods A retrospective analysis of the clinical data of 21 patients with advanced hypopharyngeal carcinoma who underwent surgery at the Shenzhen Hospital of Chinese Academy of Medical Sciences Cancer Hospital from January 1,2017 to December 31,2019 was conducted.There were 3 patients with recurrence after radiotherapy and chemotherapy,4 cases of postoperative recurrence,3 cases of postoperative recurrence after radiotherapy and chemotherapy.Three cases were hypopharyngeal carcinoma with esophageal carcinoma and 8 cases were stageⅣhypopharyngeal carcinoma.Among them,3 cases were repaired by stomach,4 cases by free jejunum,2 case by great saphenous vein for internal carotid artery,1 case by artificial blood vessel for internal carotid artery,5 cases by transfer of pectoralis major musculocutaneous flap and 2 cases by transfer of submental island flap.The 21 patients were scored using the European Cancer Research and Treatment Organization′s Quality of Life Head and Neck Tumor Special Scale(EORTC QLQ-H&N35)on the 3 months before and after surgery,and the changes in postoperative life quality were compared.Results The preoperative life quality score of 21 patients was(56.86±7.95)points and life quality score of 3 months after operation was(50.93±7.91)points.The postoperative life quality was significantly improved(P<0.05).The improvement of the postoperative life quality of the patients mainly included the improvements of the head and neck pain,swallowing function,diet,taking analgesics and indwelling nasal feeding tubes.The preoperative scores were(7.58±1.56)points,(8.46±1.63)points,(7.94±0.43)points,(1.76±0.12)points and(1.86±0.28)points,respectively,while the scores of 3 months after operation were(5.02±1.23)points,(6.28±1.58)points,(6.34±0.36)points,(1.12±0.08)points and(1.24±0.18)points,the differences were statistically significant(all P<0.05).Conclusion The flexible selection of flap repair for locally advanced hypopharyngeal carcinoma is still feasible,and surgery can improve the life quality of patients.