喉裂开联合会厌谷入路手术治疗局部晚期梨状窝癌  

Surgical approach of laryngofissure combined with epiglottis valley in treating locally-advanced pyriform sinus carcinoma

作　　者：吴平[1,2] 唐瑶云 方兴[1,2] 赵素萍 WU Ping;TANG Yaoyun;FANG Xing;ZHAO Suping(Department of Otorhinolaryngology Head and Neck Surgery,Xiangya Hospital,Central South University,Changsha 410008;Hunan Province Key Laboratory of Otorhinolaryngology Critical Diseases,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院耳鼻咽喉头颈外科,长沙410008 [2]耳鼻咽喉重大疾病湖南省重点实验室,长沙410008

出　　处：《中南大学学报（医学版）》2021年第8期843-850,共8页Journal of Central South University ：Medical Science

摘　　要：目的:探讨喉裂开联合会厌谷入路手术对治疗局部晚期梨状窝癌的可行性及疗效。方法:回顾性分析2013年1月至2019年12月中南大学湘雅医院耳鼻咽喉头颈外科收治的TNM分期为T3、T4a的下咽梨状窝癌初诊患者216例,采用3种不同的手术方式,其中包括采用喉裂开联合会厌谷入路术组(n=73)、咽侧入路梨状窝切除术组(n=75)和喉全切部分下咽切除术组(n=68),所有患者术后常规予以放射治疗,术后定期随访。采用Kaplan-Meier回归模型比较不同组间的生存率,吞咽筛查量表EAT-10评估患者术后吞咽功能,并比较各组术后气管切开导管拔管率及并发症的发生率。结果:喉裂开联合会厌谷入路组76.7%为T3期患者,咽侧入路梨状窝切除术组100%为T3期患者,喉全切部分下咽切除术组64.7%为T4a期患者,组间差异均有统计学意义(均P<0.01);临床Ⅳ期患者在3组中的比例分别为74.0%、54.7%和89.7%,组间比较差异均有统计学意义(均P<0.01)。喉裂开联合会厌谷入路组、咽侧入路梨状窝切除术组、喉全切部分下咽切除术组3年总生存率分为69.9%、53.3%和58.8%,喉裂开联合会厌谷入路组生存率优于咽侧入路梨状窝切除术组(P<0.05)。喉裂开联合会厌谷入路组患者EAT-10量表评分中位数为12.0,咽侧入路梨状窝切除术组为8.0,喉全切部分下咽切除术组为5.0,组间比较差异有统计学意义(P<0.01)。术后气管切开导管拔管率及并发症发生率组间比较差异无统计学意义(均P>0.05)。结论:喉裂开联合会厌谷入路手术治疗局部晚期梨状窝癌在生存率及喉功能的保留方面有较好的治疗效果,是一种值得提倡的保留喉功能的手术方式。Objective:To evaluate feasibility and efficacy of surgical approach of laryngofissure combined with epiglottis valley in treating locally-advanced pyriform sinus carcinoma.Methods:Clinical data of 216 patients with T3 and T4 a pyriform sinus carcinoma,who came from the Department of Otorhinolaryngology Head and Neck Surgery,Xiangya Hospital,Central South University between January 2013 and December 2019,were retrospectively analyzed.Three different types of surgery were used in these patients.Seventy-three patients were performed by approach of laryngofissure combined with epiglottis valley for partial laryngopharyngectomy(GroupⅠ);75 patients were performed by approach of lateral pharynx for piriform fossa resection(GroupⅡ);68 patients were performed by total laryngopharyngectomy(GroupⅢ).All patients were treated with radiotherapy and followed up regularly after operation.Kaplan-Meier regression model was used to analyze the overall survival rate.EAT-10 swallowing scale was utilized to evaluate the postoperative swallowing function,while the rate of tracheal tube extubation and the incidence of postoperative complications in each group were compared.Results:There were 76.7%patients with T3 stage in GroupⅠ,100%patients with T3 stage in GroupⅡ,and 64.7%patients with T4 a stage in GroupⅢ.There was significant difference between them(P<0.01).Clinical stageⅠV patients in the GroupⅠ,GroupⅡ,and GroupⅢwere 74.0%,54.7%,and 89.7%,respectively,with significant difference(P<0.01).The 3-year overall survival(OS)rate in GroupⅠ,GroupⅡ,and GroupⅢwere69.9%,53.3%,and 58.8%,respectively.Patients in the GroupⅠhad a better survival outcome than that in the GroupⅡ(P<0.05).The median score of EAT-10 swallowing scale was 12.0 in the GroupⅠ,8.0 in GroupⅡ,and 5.0 in GroupⅢ,with significant difference(P<0.01).There was no significant difference in the rate of tracheal tube extubation and the incidence of complication among the 3 groups(both P>0.05).Conclusion:Surgical approach of laryngofissure combined

关 键 词：下咽肿瘤 癌 喉功能 生存率 吞咽功能 

分 类 号：R739.6[医药卫生—肿瘤]