保留喉功能梨状窝癌的手术及诊疗体会  

Treatment experience of preservation of laryngeal function in surgical management of pyriform sinus carcinoma

作　　者：宋西成[1] 张华[1] 柳忠禄[1] 王云强[2] 王艳[1] 张强[1] 王强[1] 康沙沙[1] 宋轶鹏[3] 

机构地区：[1]烟台毓璜顶医院耳鼻咽喉头颈外科,山东烟台264000 [2]烟台毓璜顶医院头颈影像学,山东烟台264000 [3]烟台毓璜顶医院放疗科,山东烟台264000

出　　处：《山东大学耳鼻喉眼学报》2016年第3期20-23,共4页Journal of Otolaryngology and Ophthalmology of Shandong University

摘　　要：目的探讨梨状窝癌喉功能保留及功能重建方法。方法回顾性分析2004年6月至2015年10月102例保留喉功能的梨状窝癌的治疗过程,根据2002年UICC分期标准,Ⅰ期9例,Ⅱ期11例,Ⅲ期47例,Ⅳ期35例。根据术前评估分别采取咽侧入路、舌骨区入路和声门旁间隙入路切除肿瘤,肿瘤切除后同时行组织缺损修复和咽喉功能重建。93例术后实施了放疗。结果患者术后均恢复顺利,感染和咽瘘1例,所有修复方法修复材料成活,平均恢复经口进食时间12.47 d。全组患者喉功能重建良好,95例拔除了气管套管。3年、5年生存率分别为59.3%和40.7%。结论术前完善的喉镜检查和影像学评估可以为选择合适的手术入路提供指导;良好的手术入路可以为简便手术提供良好的视野、为安全切除肿瘤提供保障;术中通过会厌扭转、甲状腺加固等修复方式,可以有效减轻误咽、减少咽瘘的发生;梨状窝癌由于发现时多为晚期病例,单一的治疗手段往往不能控制病灶,需要加用放疗等措施进行综合治疗以提高局部控制率和生存率。对选择的梨状窝癌患者采取适合的手术入路和修复方式,可彻底切除肿瘤,并能保留和重建较好的咽喉功能。Objective To investigate preservation and reconstruction of larynx function in surgical treatment of pyriform sinus carcinoma. Methods A retrospective analysis of 102 cases of pyriform cancer treated in June 2004 to October2015 underwent surgeries with laryngeal functions preserved was carried out. There were 9 cases of stage Ⅰ,11 cases of stage Ⅱ,47 cases of stage Ⅲ and 35 stage Ⅳ,according to the 2002 UICC staging. Pharyngeal lateral wall approach,hyoid region approach and paraglottic space approach were chosen respectively to remove the tumor as per preoperative evaluation,followed by repairing of surgical defects and reconstruction of laryngeal and pharyngeal functions. 93 cases of postoperative radiotherapy were implemented. Results All patients recovered well after surgery except 1 patient with pharyngeal fistula and infection. All repairing materials of different methods survived and the average time of postoperative oral intake was 12. 47 days. All patients retained good laryngeal functions with 95 decannulations and the 3-year and 5-year survival rates were 59. 3% and 40. 7% respectively. Conclusion Comprehensive preoperative investigations as laryngoscopy and radiological assessment may give good suggestions in selecting appropriate surgical approaches; good surgical approach may help provide good feasibility and visibility,and ensure complete removal of the tumors with safety margins; through the epiglottis flipping and / or thyroid reinforcement repairing methods,the incidence of accidental swallowing and pharyngeal fistula can be reduced; pyriform sinus carcinoma are found mostly in advanced stages,single treatment is often ineffective in controlling the lesion,and radiotherapy is necessary as a comprehensive treatment to improve the local control rate and survival rate. Appropriate surgical approaches and repairing methods can help surgeons to completely remove the tumor,and preserve or rebuild laryngeal and pharyngeal functions in managing chosen patients with pyriform sinus cancer.

关 键 词：梨状窝癌 喉功能 修复 外科手术 

分 类 号：R766.9[医药卫生—耳鼻咽喉科]