梨状窝外侧壁癌的治疗体会  

Treatment of pyriform sinus carcinoma involving the lateral wall

作　　者：宋西成[1] 张庆泉[1] 王丽[1] 孙岩[1] 张华[1] 陈秀梅[1] 王强[1] 柳忠禄[1] 宋轶鹏[2] 

机构地区：[1]青岛大学医学院附属烟台毓璜顶医院耳鼻咽喉头颈外科,264000 [2]青岛大学医学院附属烟台毓璜顶医院放疗科,264000

出　　处：《中华耳鼻咽喉头颈外科杂志》2013年第4期300-306,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：山东省科技发展计划（2011YD18014）;山东省优秀中青年科学家科研奖励基金（2007BS03009）;烟台市科技发展计划（2008142-21）

摘　　要：目的探讨梨状窝外侧壁癌的临床特点、治疗措施及疗效。方法回顾性分析1997年6月至2009年6月77例梨状窝外侧壁癌患者的临床资料。根据2002年UICC分期标准，I期8例，Ⅱ期10例，Ⅲ期32例，Ⅳ期27例。将病例分成两组，一组单纯行放射治疗（R组）17例，另一组为手术＋放疗（sR组）60例，放射剂量50～75Gy。sR组根据病变情况分别采取舌骨区和咽侧手术入路切除肿瘤，术后通过局部拉拢缝合、带状肌肌筋膜瓣、胸大肌肌皮瓣、联合裂层皮片或异种（牛）脱细胞真皮基质修复膜等方式行组织缺损修复和咽喉功能重建。结果R组17例放疗结束后15例原发灶及颈部转移淋巴结消失；1例N3患者颈部淋巴结缩小，局部未控制，7个月后死于全身转移；1例N2患者，放疗满疗程后颈部肿物显著缩小，PET—CT和穿刺活检未发现癌变，半年后肿物再次长大，并于11个月后死于颈部大出血。SR组所有修复组织及修复材料成活，术后伤口感染2例，发生咽瘘2例。全组患者保留了全部喉功能。SR组全部病例术后12—30d恢复经口进食，平均恢复进食时间15．6d。全组病例3年、5年生存率分别为59．1％和41．4％；I期＋Ⅱ期病例SR组和R组3年、5年生存率分别为63．6％、53．0％和66．7％、50．0％，两者相比差异无统计学意义（X2=0．021，P=0．884）；Ⅲ期＋Ⅳ期病例SR组和R组3年、5年生存率分别为63．9％、43．7％和16．4％、0，两者相比差异有统计学意义（X2=20．496，P=0．000）；全部病例SR组和R组3年、5年生存率分别为63．6％、45．8％和41．5％、24．9％，两者相比差异有统计学意义（X2=4．644，P=0．031）。结论梨状窝外侧壁癌多在黏膜表面或黏膜下弥漫生长，浸润生长者容易侵犯甲状软骨板向外扩展。早期病例放疗可以获得较好的治疗效果，晚期病例具备手术适应证者应采取手术＋放疗的�Objective To present and discuss the clinical features, treatment, and efficacy of pyriform sinus carcinoma involving the lateral wall. Methods Seventy-seven patients with pyriform sinus cancer involving the lateral wall （stage I 8, stage ]I 10, stage m 32, stage IV 27, according to UICC 2002 staging） were treated from Jun 1997 to Jun 2009 in the department of otorhinolaryngology head and neck surgery, Yuhuangding Hospital. The patients were divided into two groups： Group one 17 cases, simply underwent radiation therapy （R group） ; Group two 60 cases underwent surgery plus postoperative radiation （SR group ） . All patients underwent radiotherapy 50 - 75 Gy. In SR group, hyoid area and lateral pharyngeal approaches were taken according to the lesions for resection. To repair the defects and reconstruct the functions of larynx and pharynx, regional roping in suture, fascial flap/muscular- fascial of strap muscles, glosso-flap, musculocutaneous flap of major pectoral muscle, joint split graft or heterologous （bovine） acellular dermal matrix were used respectively. Results In group R, the primary tumor and neck lymph node metastasis disappeared at the end of radiotherapy in 15 cases. For one case, the N3 cervical lymph nodes shrank, but failed in local control and died of systemic metastases after 7 months. For another case, the N2 neck lymph nodes significantly reduced after the full course of radiation, PET-CT and biopsy did not find the cancer, but the tumor grew again after 6 months, and died of a neck bleeding 11 months later. All repairing materials used were alive in SR group. Two cases developed postoperative wound infection, and 2 cases suffered from pharyngeal fistula. All patients retained laryngeal functions, and all patients in SR group recovered diet 12 -30 days, the mean time was 15.6 days. Three and 5 year survival rates for all 77 patients were 59. 1% and 41.4%. For stage I ＋ stage ]I cases in SR group and R group, 3 and 5 year survival rates were 63.6% , 53.0% and 66. 7% , 50. 0%

关 键 词：下咽肿瘤 癌 鳞状细胞 咽切除术 预后 

分 类 号：R739.63[医药卫生—肿瘤]