39例环后癌的外科治疗及临床疗效分析

Surgical treatment and clincal efficacy of postcricoid carcinoma in 39 cases

目的探讨环后癌的外科治疗方法及临床疗效。方法回顾性分析2010~2018年行外科治疗的39例环后癌患者,其中男38例,女1例;年龄39~70岁。根据2002年UICC分期规定:Ⅰ期7例,Ⅱ期7例,Ⅲ期8例,Ⅳ期17例。行保留喉功能者25例,不保留喉功能者14例;在完整切除肿瘤后进行咽喉功能的修复重建。术前诱导化疗+手术+术后辅助放疗者15例,手术+术后辅助放疗者14例,术前诱导化疗+手术者8例,单纯手术者2例。结果术后出现咽瘘5例,下咽狭窄2例,分别予换药和食管镜下扩张后Ⅱ期愈合。随访时间5~65个月,随访5年及以上者5例,健在1例;随访3年以上者18例,健在7例,其余未随访至3年,7例失访。经Log-rank检验,是否保留喉功能组间、进行术前诱导化疗联合术后辅助放疗的患者与仅进行术后辅助放疗的患者组间、患者有无淋巴结转移组间、及Ⅰ-Ⅱ期与Ⅲ-Ⅳ期组间生存率差异均无统计学意义(P>0.05)。结论随着环后癌外科治疗的发展,在安全切除癌灶的基础上可酌情保留中晚期喉功能,结合外科综合治疗可一定程度提升患者生活质量。

Objective To investigate the surgical treatment and clinical efficacy of postcricoid carcinoma.Methods Clinical data of 39 cases suffering from postcricoid carcinoma surgically treated from 2010 to 2018 were analyzed retrospectively.Of them 38 were male and 1 was female,aged from 39 to 70 years old.According to the UICC staging system in 2002,their clinical stages were as follows:7 cases were in stageⅠ,7 in stageⅡ,8 in stageⅢand 17 in stageⅣ.The laryngeal function was retained in 25 cases and not retained in 14.The pharyngeal and laryngeal functions were reconstructed after complete resection of the tumors in all cases.As for the adjuvant therapy,15 cases underwent preoperative induction chemotherapy and post-operative radiotherapy,14 cases underwent post-operative radiotherapy,8 cases underwent preoperative induction chemotherapy,and 2 received surgical treatment alone.Results Postoperative pharyngeal fistula and hypopharyngeal stenosis occurred in 5 and 2 cases,and were healed in stageⅡby dressing and esophagoscopic dilatation respectively.The follow-up period ranged from 5 to 65 months.7 cases were lost to follow-up.One of the 5 cases who had been followed up for 5 years and above was alive.18 cases had been followed up for more than 3 years,and 7 were alive.The follow up period was shorter than 3 years in the remaining 9 cases.Log-rank test showed that there were no significant differences in survival rates between groups with and without laryngeal function preservation,with and without preoperative induction chemotherapy,with and without cervical lymph node metastasis,and those in stageⅠ~Ⅱand stageⅢ~Ⅳ(all P>0.05).Conclusion With the development of surgical treatment for postcricoid carcinoma,the laryngeal function can be preserved appropriately in middle and advanced cases on the basis of safe excision of cancer focus,which can improve the quality of life of patients to some extent while combined with comprehensive surgical treatment.