下咽癌保留喉功能45例的临床分析  

Clinical analysis on preservation of laryngeal function in 45 cases of laryngopharyngeal neoplasms

作　　者：姜元芹[1] 颜志平[1] 孙永明[1] 赖世佳[1] 赖昭安[1] 童梓德[1] 赵德安 

机构地区：[1]解放军第174医院耳鼻咽喉科,福建厦门361003

出　　处：《临床军医杂志》2013年第8期825-826,共2页Clinical Journal of Medical Officers

摘　　要：目的探讨45例保留喉功能的下咽癌手术方法及疗效。方法对45例下咽癌患者的临床资料和治疗情况进行回顾性分析，经手术治疗的下咽恶性肿瘤45例（按UICCTNM分类分期，T1NOM01例，T2N0M03例，T2N1Mo5例，T3N1M011例，T3N2M015例，T4N1M04例，T4N2M06例），其中梨状窝癌34例，环后癌2例，下咽后壁区癌9例。45例作了喉功能保留手术，术后给予放射治疗，剂量50～70Gy。结果45例患者术后均获得随访，随访率100％，3年生存率为64．4％（29／45），5年生存率为40．O％（18／45）。术后发生切口感染、咽瘘和肺部感染等并发症21例；其中切口感染12例，咽瘘7例，肺部感染2例。45例患者中，33例拔除气管套管，拔管率73．3％；29例患者术后喉功能包括发音功能、呼吸功能、吞咽功能得到保留，占本组病例的64．4％。另16例术后发音功能、吞咽功能等喉部分功能得到保留，占35．6％。结论采用保留喉功能手术治疗下咽癌是十分必要的。绝大多数患者下咽癌保留喉功能是切实可行的。Objective To investigate the surgical method of preservation of laryngeal function and its effect on 45 cases of laryngo- pharyngeal neoplasms. Methods ： A review was done on 45 patients with malignant hypopharyngeal neoplasms treated from January 2000 to January 2009 in our department. Of the 45 patients （T1N0M0 in 1, T2N0M0 in 3, T2N1M0 in 5, T3N1M0 in 11, T3N2M0 in 15, T4Ni M0 in 4 and T4N2M0 in 6 ones） , 34 were originated from pyriform sinus, 2 from postcricoid space and 9 from posterior pharyngeal wall. All the patients were surgicaIIy treated with laryngeal function preserved, and received 50 -70 Gy postoperative radiotherapy. Results All the patients were followed up from 3 to 10 years. Their 3-and 5-year survival rates were64.4% （29/45） and 40.0% （ 18/45 ）, respectively. Moreover, 21 patients encountered postoperative complications, including incisional infection （ n = 12 ）, pharyngo-cutaneous fistula（ n = 7 ） and pulmonary infection （ n = 2 ）. Decannulation was carried out in 33 patients （73.3 % ）, and 29 patients （64.4%） had all the functions （voice, respiration and deglutition） preserved and 16 ones （35.6%） partially pre- served （voice and deglutition）. Conclusion The preservation of the normal part of the larynx is feasible for the eradication of tumor.

关 键 词：咽部肿瘤 修复外科手术 保留喉功能 

分 类 号：R739.63[医药卫生—肿瘤]