梨状窝癌术后修复与综合治疗疗效分析  

Postoperative outcomes of reconstruction surgery and comprehensive treatments for pyriform sinus carcinoma

作　　者：沈志森[1] 成立新[1] 邬振华[1] 裘世杰[1] 杨驱云[1] 叶栋[1] 

机构地区：[1]宁波市医疗中心李惠利医院耳鼻咽喉头颈外科,315010

出　　处：《浙江医学》2012年第6期412-414,463,共4页Zhejiang Medical Journal

基　　金：宁波市重大科技攻关择优项目（2008C50019）

摘　　要：目的 探讨梨状窝癌切除术后,保留与不保留喉功能的修复方法及术后综合治疗的疗效.方法 选取梨状窝癌患者85例,TNM分期：Ⅰ期5例,Ⅱ期11例,Ⅲ期26例,Ⅳ期43例.Ⅲ、Ⅳ期患者中不保留喉功能31例（咽修复方法：直接修复、横行舌瓣修复、胸大肌肌皮瓣、喉气管瓣、胃代食管咽、游离空肠代咽与颈段食管）;保留喉功能38例（喉修复方法：垂直半喉切除直接修复、改良会厌喉成形术、颈前肌筋膜瓣修复,以及前臂游离皮瓣和股外侧游离皮瓣同时修复喉与咽）.单侧颈淋巴结清扫（颈清）56例,双侧颈清29例,其中行肿瘤同侧甲状腺切除29例.所有患者术后常规放疗,并行随访,失访按死亡计.结果 本组患者1、3、5年存活率分别为94.1%（5/85）、66.7%（24/72）和52.9%（24/51）,保留与不保留喉功能者3年存活率分别为63.2%（24/38）与48.4%（15/31）,差异有统计学意义（P＜0.01）;5年存活率分别为51.7%（15/29）与40.9%（9/22）,差异有统计学意义（P＜0.01）.38例喉功能保留患者拔管26例,拔管率68.4%.结论 早期发现梨状窝癌有助于提高存活率.对Ⅲ、Ⅳ期患者,在快速病理确认安全边缘前提下切除肿瘤后,根据喉与下咽组织缺损情况,尽可能利用残喉及游离或带蒂组织瓣修复喉支架及下咽,有利于咽喉功能的恢复,可提高患者生存质量与存活率.Objective To evaluate the efficacy of reconstruction surgery with partial laryngectomy or total laryngectomy and comprehensive postoperative treatment for pyriform sinus carcinoma. Methods The clinical data of 85 patients with pyriform sinus carcinoma were retrospectively analyzed. The TNM stages Ⅰ , Ⅱ, Ⅲ and IV were 5, 11, 26 and 43 cases respectively. For 16 patients with early stages （ Ⅰ and Ⅱ ） the stumps were fixed directly; and for 69 patients with later stages （ Ⅲand Ⅳ） 31 cases were treated by total laryngectomy and hypopharynx reconstruction, in which 4 cases were reconstructed by direct suture, 11 cases were rehabilitated with transverse tongue flap, 7 cases with pectoralis major myocutaneous flap, 2 cases with replacement of esophagus and hypopharyngeal with stomach, 2 cases with replacement of esophagus and hypopharyngeal by free vascularized jejunum segment. Among 69 patients, 38 cases were treated with partial laryngectomy, in which 11 cases by vertical hemilaryngectomy, 14 cases by modified epiglottic laryngoplasty, 9 cases by infrahyoid muscular flap, 3 cases by free forearm flap and 1 case by anterolateral thigh flap. The selective neck dissection were done unilaterally （56 cases） or bilaterally （29 cases）. And 29 cases underwent thyroidectomy unilaterally. Results The 1, 3 and 5-y survival rates were 94.1%（5/85）, 66.7% （24/72） and 52.9% （24/51） respectively. The 3-y survival rate for 31 patients with partial laryngectomy was 63.2% （24/38） and for 38 patients with total laryngectomy was 48.4%（15/31） （P〈0.01）; the 5-y survival for two groups was 51.7%（15/29） and 40.9% （9/22） （P 〈0.01）. The tracheal cannula was removed after operation in 68.4% patients （26/38） with partial laryngectomy. Conclusion Early diagnosis of pyriform sinus carcinoma is helpful to improve the postoperative survival rate, the rehabilitation of laryngeal function and the quality of life for patients.

关 键 词：下咽肿瘤 梨状窝癌 外科 综合治疗 

分 类 号：R743.2[医药卫生—神经病学与精神病学]