65岁以上高龄下咽癌患者的功能保全性手术治疗  

The options of surgery and laryngeal preservation for hypopharyngeal cancer patients more than 65 years old

作　　者：王琴[1,2,3] 刘业海[1] 胡国勤[1] 吴开乐[2,3] 高朝兵[1] 赵益[1] 

机构地区：[1]安徽医科大学第一附属医院耳鼻咽喉头颈外科,合肥230022 [2]安徽医科大学附属合肥医院 [3]合肥市第二人民医院耳鼻咽喉科,合肥230032

出　　处：《临床耳鼻咽喉头颈外科杂志》2015年第4期334-338,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：安徽省教育厅重点项目(No:KJ2012A162)

摘　　要：目的:探讨>65岁高龄下咽癌患者喉功能保留手术的疗效。方法:>65岁高龄下咽癌患者58例,分为喉功能保留组31例和喉功能未保留组27例。术前均行完善的术前准备,术中肿瘤切除标本送冷冻证实切缘阴性后应用局部缝合、带状肌皮瓣、胸大肌皮瓣、裂层皮片、胃代食管等对缺损进行修复,术后均行根治性放疗。用Kaplan-Meier法计算生存率,用卡方检验比较两组并发症。结果:所有患者3、5年生存率分别为48.3%(28/58)和27.6%(16/58)。喉功能保留组3、5年生存率分别为51.6%(16/31)和29.0%(9/31);喉功能未保留组分别为44.4%(12/27)和25.9%(7/27),3、5年生存率差异均无统计学意义(P>0.05)。两组并发症的发生率分别为45.2%(14/31)和40.7%(11/27),差异无统计学意义(P>0.05)。结论:高龄下咽癌患者根据其全身状况及肿瘤的侵犯范围选择喉功能保全是可行的,关键是充分做好围手术期处理,正确掌握适应证,提高术中修复技巧。Objective：To study the effectiveness of preserving laryngeal function for senile hypopharyngeal cancer patientsolder than 65.Method：The clinical data of 58 surgery cases of senile hypopharyngeal cancer patients more than 65 years old were colleted and analyzed.Thirty-one cases preserved the laryngeal function,while the rest did not.Perfect preoperative preparation was done before surgery.Surgical resection specimens were sent to frozen-section examination.When the negative incisal margin was confirmed,the defect was repaired by the appilication of local stitching,ribbon muscle flap,major myocutaneous flaps,split thickness skin and replacement of esophagus by stomach.Radical radiotherapy was used after surgery.Survival rate was calculated by the KaplanMeier method.Chi-square test was used to compare complications of the two groups.Result：The 3years and 5years survival rate for all cases were 48.3%（28/58）and 27.6%（16/58）,respectively.For patients with laryngeal function preservation,the 3years and 5years survival rate were 51.6%（16/31）,29.0%（9/31）,respectively.For cases without laryngeal function preservation,the 3years survival rate and 5years survival rate were 44.4%（12/27）,25.9%（7/27）,respectively.The result showed no obvious difference in survival rate between two groups（P〉0.05）.Surgery complication rate were 45.2%（14/31）and 40.7%（11/27）,without obvious differences between the two groups（P〉0.05）.Conclusion：It is feasible for senile hypopharyngeal cancer patients to choose suitable operation based on their physical conditions and the tumor extension.The key issues include well perioperative treatment management,correct indications grasp,and intraoperative repair skills improvement.

关 键 词：咽肿瘤 咽切除术 喉切除术 老年人 

分 类 号：R739.63[医药卫生—肿瘤]