21例保留喉功能下咽癌手术的临床体会

Clinical study of surgical treatment of 21 hypopharyngeal cancer patients with laryngeal function preservation

目的探讨下咽癌保留喉功能的手术方法及临床疗效。方法回顾性分析2015年7月~2018年6月蚌埠医学院第一附属医院行手术治疗,保留喉功能的下咽癌患者的临床资料,对其肿瘤位置、手术方式、切除修复方式、术后恢复情况、生存率进行分析。结果共收集保留喉功能的下咽癌病例21例,分别为梨状窝癌16例,下咽后壁癌3例,环后区癌2例。手术方式如下:对于梨状窝癌,单纯梨状窝切除6例,垂直部分喉、患侧梨状窝切除8例,梨状窝切除颏下动脉穿支皮瓣转移修复2例。原发于下咽后壁的T1病例1例,原发灶切除选择咽侧径路,切除病变,局部黏膜拉拢缝合;原发于下咽后壁的T3病例2例,行下咽后壁癌扩大切除颏下动脉穿支皮瓣转移修复。环后区癌行病灶扩大切除及环状软骨板部分切除,梨状窝食管黏膜上拉修复缺损重建喉下咽功能。21例患者术后无严重并发症,2例出现咽瘘,换药3周内愈合,所有患者术后喉功能良好,5例术后2周内有进食呛咳,2周后呛咳消失。所有患者均能经口进食,1例患者放疗后出现食管狭窄,后经扩张治疗后好转,目前进食半流质无困难。截止目前,1年生存率95.1%(20/21),3年生存率71.33%(15/21)。结论下咽癌病例经过适当选择,可以保留喉功能,且不降低患者生存期,采取适当的切除范围选择合适的修复方式能使患者获得最佳的喉及下咽功能,提高患者生活质量,值得临床推广,但是病例的选择至关重要。

Objective To explore the surgical methods and clinical efficacy of hypopharyngeal cancer with laryngeal function preservation.Methods Retrospective analysis of 21 cases with throat function retention surgery at the First Affiliated Hospital of Bengbu Medical College from July 2015 to June 2018 were completed.Clinical data for patients with pharynx cancer were collected.The tumor location,operation method,resection and repair method,postoperative recovery and survival rate were analyzed.Results A total of 21 cases of hypopharyngeal carcinoma with laryngeal function preservation were collected,including 16 cases of piriform fossa carcinoma,3 cases of posterior wall carcinoma and 2 cases of postcricoid region carcinoma.The surgical methods were as follows:for piriform fossa cancer,piriform fossa was resected in 6 cases,vertical part of larynx and affected side piriform fossa were resected in 8 cases,piriform fossa was resected in 2 cases with submental artery perforator flap.There was 1 case of T1 originating in the posterior wall of the hypopharynx and in 2 cases of T3 with primary inferior pharyngeal posterior wall cancer,submental artery perforator flap was used for repair.Enlarged resection of the lesion and partial resection of the cricoid cartilage plate were performed for the carcinoma in the posterior ring area,and the piriform fossa esophageal mucosa was pulled up to repair the defect and reconstruct the laryngeal and hypopharyngeal function.All of the 21 patients had good throat function,5 patients had a slight cough when eating,and after 2 weeks of exercise,they were able to eat normally.Pharyngeal fistula occurred in 2 cases and healed within 3 weeks after dressing change.All patients regained swallowing function,and one patient developed esophageal stenosis after radiotherapy,which was improved after dilation treatment.All patients were followed up after surgery,1-year survival rate was 95.1%(20/21)and 3-year survival rate is 71.33%(15/21).Conclusion After proper selection of hypopharyngeal cancer cases,the laryngeal function can be preserved without reducing the survival of patients.Appropriate resection scope and selection of appropriate repair methods can enable patients to obtain the best laryngeal and hypopharyngeal function and improve the quality of life of patients,which is worthy of clinical promotion,but the selection of cases is also crucial.