外科治疗下咽癌96例分析

Surgical treatment of hypopharyngeal carcinoma

目的 探讨下咽癌的外科治疗效果。方法 回顾性分析 1970— 1998年间 96例 (男性 85例 ,女性11例 ,年龄 35～ 74岁 )经手术治疗的下咽癌 ,病理均为鳞状细胞癌。单纯手术 31例 ,综合治疗 6 5例。4 2例 (44 % )作了喉功能保留手术 ,5 4例 (5 6 % )未保留喉功能。同期单颈清扫 5 5例 ,双颈清扫 2 7例。结果 96例总 5 a生存率为 35 %。单纯手术 5 a生存率为 2 3% ,综合治疗为 4 2 %。喉功能保留组为 38% ,未保留组为 33% ,两组差异无显著性。淋巴结转移率为 81% ,并发症发生率为 35 % ,以咽瘘最常见。结论 下咽癌治疗以综合治疗较单纯手术效果好。不影响生存率的前提下 ,保留喉功能的下咽癌手术较未保留喉功能者 ,有效地提高了生存质量。对于下咽癌 c N1～ 3者 ,应该行根治性颈清扫 ;对于 c N0 者 ,倾向行颈侧清扫术。

Objective To study the result of surgical treatment in patient with hypopharyngeal carcinoma.Methods A retrospective analysis for 96 cases with hypopharyngeal carcinoma from 1970 to 1998 who underwent surgical treatment (male 85 cases,female 11 cases,35～74 years old).Among them,operation alone 31 cases,combined treatment 65 cases,operation with reservation of laryngeal function 42 cases (43.8%),without reservation of laryngeal function 54 cases (56.2%).Unilateral radical neck dissection (RND) 55 cases,bilateral RND 27 cases.Results The 5 year survival rate of the total 96 cases was 35.4%;that of operation alone group was 22.6%;of combined treatment group was 41.5%;of the group with reservation of laryngeal function was 38.1%,and of the group without reservation of laryngeal function was 33.3%,there was no significant difference between the latter two groups.Metastasis rate in cervical lymphnode was 80.5%.Pharyngeal fistula was the most common complication.Conclusion Combined treatment is advisable for the patients with hypopharyngeal carcinoma.On the premise of not affecting the survival rate,operation with reservation of laryngeal function can effectively improve the patient′s life quality.For the patients with hypolaryngeal carcinoma of cN 1～3 category,RND is advisable;and for cN 0,functional neck dissection is suitable.