下咽癌侵犯食管入口的临床特征及治疗分析  

Clinical features and treatment analysis of esophageal entrance invasion in hypopharyngeal carcinoma

作　　者：吴娟[1] 周兰柱[1] 孙哲[1] 吴俊[1] 王文忠[1] WU Juan;ZHOU Lanzhu;SUN Zhe;WU Jun;WANG Wenzhong(Department of Otolaryngology and Head and Neck Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院耳鼻咽喉头颈外科,安徽蚌埠233004

出　　处：《中华全科医学》2023年第6期954-957,共4页Chinese Journal of General Practice

基　　金：安徽省自然科学基金项目(KJ2020A0568,KJ2020A0590)。

摘　　要：目的分析下咽癌侵犯食管入口的基本临床特点,总结治疗效果并选择合适的综合治疗方案。方法回顾性分析2014年1月—2017年1月蚌埠医学院第一附属医院耳鼻咽喉头颈外科手术治疗的32例下咽鳞状细胞癌侵犯食管入口的病例,收集患者临床基本信息,随访术后生存情况,分析下咽癌侵犯食管入口的基本临床特点及治疗疗效。结果32例患者皆为男性,年龄为44~81(62.7±9.0)岁,其中梨状窝癌28例、咽后壁癌2例、环后癌2例。肿瘤TNM分期:T3N1M02例,T3N2M05例,T3N3M01例,T4N1M01例,T4N2M020例,T4N3M03例。肿瘤病理均为鳞状细胞癌,病理分级:高分化3例,中分化14例,低分化15例。所有患者手术均成功完成,行根治性颈清扫术25例,选择性颈清扫术7例。3年总生存率为62.5%(20/32);5年总生存率为34.4%(11/32)。未保留喉功能24例,3年生存率为66.7%(16/24),5年生存率为37.5%(9/24)。术中保留喉功能8例,3年生存率为50.0%(4/8),5年生存率为25.0%(2/8)。其中喉功能(呼吸、发音及吞咽保护)全恢复5例(62.5%),发音及吞咽保护恢复3例(37.5%)。结论下咽癌侵犯食管入口恶性程度高,预后较差。应积极完善术前检查,根据肿瘤分期及患者身体状况选择治疗方案,主要采取以手术为主的综合治疗。Objective To analyze the basic clinical characteristics of esophageal entrance invasion in hypopharyngeal carcinoma,summarize the therapeutic effect and select the appropriate comprehensive treatment plan.Methods A total of 32 patients with hypopharyngeal squamous cell carcinoma invading the esophageal entrance treated by Otolaryngology Head and Neck Surgery at the First Affiliated Hospital of Bengbu Medical College from January 2014 to January 2017 were retrospectively analyzed.The basic clinical information of patients were collected,postoperative survival was followed up,and the basic clinical characteristics and treatment efficacy of hypopharyngeal cancer invading the esophageal entrance were analyzed.Results The 32 patients were all male,aged 44 to 81(62.7±9.0)years old,including 28 piriform fossa carcinoma,2 retropharyngeal wall carcinoma and 2 posterior annular carcinoma.Tumor TNM stage:2 cases of T3N1M0,5 cases of T3N2M0,1 case of T3N3M0,1 case of T4N1M0,20 cases of T4N2M0,and 3 cases of T4N3M0.The tumor pathology was all squamous cell carcinoma,with pathological grade:3 patients were highly differentiated,14 patients were moderately differentiated,and 15 patients were poorly differentiated.The operation was successfully performed in all patients,25 cases underwent radical neck dissection and 7 cases underwent selective neck dissection.The 3-year overall survival rate was 62.5%(20/32),and the 5-year overall survival rate was 34.4%(11/32).In 24 cases of unreserved laryngeal function,the 3-year survival rate was 66.7%(16/24),and the 5-year survival rate was 37.5%(9/24).There were 8 cases preserved laryngeal function,with a 3-year survival rate of 50.0%(4/8)and a 5-year survival rate of 25.0%(2/8).Among them,5 cases(62.5%)had complete recovery of laryngeal function(respiratory,vocal,and swallowing protection),and 3 cases(37.5%)had recovery of vocal and swallowing protection.Conclusion Hypopharyngeal carcinoma invading esophageal entrance has high malignancy degree and poor prognosis.Preoperative examination

关 键 词：下咽癌 食管入口 喉功能保全 生存率 

分 类 号：R739.63[医药卫生—肿瘤] R730.56[医药卫生—临床医学]