36例下咽后壁鳞状细胞癌的临床分析  

Clinical Analysis of Posterior Hypopharyngeal Wall Squamous Cell Carcinoma: a Report of 36 Cases

作　　者：王建宏[1] 祁永发[1] 唐平章[1] 温树信[1] 张宗敏[1] 秦德兴[2] 

机构地区：[1]中国协和医科大学中国医学科学院肿瘤研究所/肿瘤医院头颈外科,北京100021 [2]中国协和医科大学中国医学科学院肿瘤研究所/肿瘤医院放射治疗科,北京100021

出　　处：《癌症》2005年第9期1106-1110,共5页Chinese Journal of Cancer

摘　　要：背景与目的:下咽后壁鳞状细胞癌临床少见。本研究旨在探讨下咽后壁鳞状细胞癌的治疗方式及下咽部的一期修复与功能恢复方法。方法:回顾性分析中国医学科学院肿瘤医院头颈外科与放射治疗科1967年6月～2000年1月收治的36例下咽后壁鳞状细胞癌(1997年UICC分期:I期4例;II期4例;Ⅲ期9例;Ⅳ期19例)的临床资料,其中男性24例,女性12例。采用综合治疗(手术加放射)20例,根治性放疗10例,单纯手术3例,根治性放疗后挽救手术3例(2例颈部、1例颈部与下咽)。一期修复所用组织有胃、空肠、结肠、胸大肌、前臂皮瓣、残喉、胃网膜、颈阔肌皮瓣、斜方肌皮瓣等器官与皮瓣。结果:综合治疗、根治性放疗的5年生存率分别为40%(8/20)、30%(3/10)。单纯手术3例3年内2例死亡,1例失随。挽救手术3例均3年内死亡。对原发灶24例手术治疗患者中留喉下咽后壁局部切除4例(16.7%);一期修复20例(83.3%),其中利用胃、空肠器官修复11例(55%),其它修复9例(45%)。一期修复手术无围手术期死亡,并发症发生率为15%(3/20),修复有效率为85%(17/20),平均进食时间为2～3周。修复患者中局部复发3例。结论:综合治疗在下咽后壁鳞状细胞癌中疗效肯定,治疗的重点为下咽吞咽功能的恢复。手术一期重建下咽部,恢复患者吞咽功能,不增加患者预后的风险。胃、空肠代下咽是重要的修复手段。部分患者可选择局部切除,保留喉功能。BACKGROUND ＆ OBJECTIVE： Posterior hypopharyngeal wall squamous cell carcinoma is few in clinic. This study was to discuss its treatment and the simultaneous reconstruction and function of hypopharyngeal wall. METHODS： Clinical data of 36 posterior hypopharyngeal wall squamous cell carcinoma patients （24 men and 12 women; 4 in stage I , 4 in stage Ⅱ , 9 in stage Ⅲ, 19 in stage IV）, treated in Cancer Hospital of Chinese Academy of Medical Sciences between Jun. 1967 and Jan. 2000, were retrospectively analyzed. Of the 36 patients, 20 received combined therapy （surgery plus radiotherapy）, 10 received radical radiotherapy, 3 received surgery alone, 3 received salvage surgery after failure of radiotherapy （2 at neck, 1 at hypopharynx and neck）. Simultaneous reconstruction of hypopharyngeal wall used gastric tissue, jejunum tissue, ileum tissue, musculi pectoralis majoris flap, forearm flap, larynx tissue, gastroepiploic tissue, platysmal flap, and musculus trapezius flap. RESULTS： The 5-year survival rates were 40% in combined therapy group, and 30% in radical radiotherapy group. In surgery alone group, 2 patients were died, and 1 was lost of follow-up. All 3 patients in salvage surgery group were died within 3 years. Of the 24 patients underwent surgery, 4 （17%） underwent local resection, 20 （83%） underwent hypopharyngeal reconstruction~ of the 20 patients, 11 （55%） patients used gastric tissue or jejunum tissue, and 9 （45%） patients used other tissues; no patient died during perioperationl the occurrence of complications was 15%; the reconstruction success rate was 85%; the mean time to eating was 2-3 weeks; 3 patients suffered local recurrence. CONCLUSIONS： The combined therapy, emphasized on resume swallow function, has good effect on posterior hypopharyngeal wall squamous cell carcinoma. Simultaneous reconstruction of hypopharynx may resume swallow function without increase of prognosis hazard. Gastric and jejunum tissues are mainly used in reconstruction. Local resection

关 键 词：下咽部肿瘤 癌 鳞状细胞 外科手术 放射治疗 综合治疗 一期修复 功能重建 预后 

分 类 号：R739.62[医药卫生—肿瘤]