喉咽后壁区癌手术治疗  

Surgical treatment of the carcinoma of the posterior wall of the hypopharynx

作　　者：吕正华[1] 栾信庸[1] 潘新良[1] 解光[1] 许风雷[1] 刘大昱[1] 雷大鹏[1] 

机构地区：[1]山东大学齐鲁医院耳鼻咽喉科,山东济南250012

出　　处：《中国耳鼻咽喉头颈外科》2005年第4期223-225,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨喉咽后壁区癌的手术方法、疗效和保留喉功能的可行性。方法回顾性分析于1997～2003年行手术治疗的喉咽后壁区癌21例。男19例,女2例;年龄35～78岁;根据1971年UICC分期的规定:Ⅰ期2例,Ⅱ期3例,Ⅲ期4例,Ⅳ期12例。6例以局部黏膜拉拢缝合修复,2例行裂层皮瓣修复,1例行颈阔肌皮瓣修复,7例以残喉气管瓣修复,1例行胸大肌皮瓣修复,1例以胸大肌联合喉气管瓣修复,其余3例行全喉及全喉咽切除后以胃上提及结肠上徙修复。10例行单侧,11例行双侧选择性或改良根治性颈清扫术。术后病理5例有淋巴结转移,占23.8%。19例术后行辅助性放疗。结果21例术后均Ⅰ期愈合,吞咽功能恢复良好,其中11例保留了全部或部分喉功能。经6个月～7年随访,随访5年及以上者3例,健在1例,生存率1/3;随访3年以上者13例,健在5例,生存率38.5%;其余8例随访未及3年。结论喉咽后壁区癌的T1￣2级病变宜行保留全喉功能的手术,细心选择的T3￣4级病变可保留部分喉功能,手术方式和重建方法的选择对彻底切除喉咽后壁区癌并保留喉功能十分重要。OBJECTIVE To study of the surgical methods, the results and the feasibility of laryngeal func-tion preservation of the carcinoma of the posteriorhypopharyngeal wall. METHODS A retrospective studyof 21 cases with the carcinoma of the posteriorhypopharyngeal wall whom were treated from 1997 to2003 was carried out. There were 19 males and 2 fe-males and the ages ranged from 35 to 78 years. Of the21(stageⅠ,2;Ⅱ,3;Ⅲ,4;Ⅳ,12) cases,6 were reconstrutedby re-suturing mucosa, 2 by intermediate split skin flap,1 by cervical skin flap,7 by laryngotracheal flap,1 by pec-toralis major myocutaneous flap,1 by laryngotracheal flapand pectoralis major myocutaneous flap, and 3 by gas-tric pull-up or colon interposition. Ten cases underwentunilateral elective or modified radical neck dissection and11 cases underwent bilateral neck dissection. Five cases(23.8 %) had cervical lymph nodes metastasis. Nineteencases had postoperative radiotherapy. RESULTS All thepatients restored the deglutition functions satisfactorily.Eleven cases restored the laryngeal functions completelyor partially. All patients were followed up from 6 monthsto 7 years. The 3 and 5 year survival rate were 38.5 %(5/13)and 33.3 %(1/3) respectively. CONCLUSION Posteriorhypopharyngeal wall T1-2 lesions were feasible to preservelaryngeal functions completely and carefully selected T3-4lesions were feasible to preserve laryngeal functions partially.The Kinds of surgical procedures and reconstructive tech-niques were very important for the eradication of the tumorand preservation of the laryngeal functions.

关 键 词：咽后壁区癌 手术治疗 1997~2003年 改良根治性颈清扫术 保留喉功能 肌皮瓣修复 UICC分期 吞咽功能恢复 喉气管瓣 回顾性分析 淋巴结转移 辅助性放疗 手术方法 缝合修复 结肠上徙 术后病理 7年随访 保留部分 重建方法 手术方式 

分 类 号：R739.63[医药卫生—肿瘤] R653[医药卫生—临床医学]