行手术为主导治疗模式的456例下咽癌疗效分析  

Efficacy of surgical comprehensive therapy for 456 cases of hypopharyngeal carcinoma

作　　者：吕正华 徐伟 马聚珂 冯守昊 靖培航 刘旭良 周超 Lyu Zhenghua;Xu Wei;Ma Juke;Feng Shouhao;Jing Peihang;Liu Xuliang;Zhou Chao(Department of Head and Neck Surgery,Shandong Provincial ENT Hospital,Jinan 250023,China)

机构地区：[1]山东省耳鼻喉医院头颈外科,济南250023

出　　处：《中华耳鼻咽喉头颈外科杂志》2023年第6期558-564,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的:总结以手术为主导治疗模式在下咽癌治疗中的疗效。方法:回顾性分析2014—2019年山东省耳鼻喉医院头颈外科收治的456例原发下咽鳞癌患者的临床资料,男性432例,女性24例,年龄37~82岁。其中梨状窝癌328例,下咽后壁癌88例,环后癌40例。Ⅲ-Ⅳ期420例(92.1%),T3-4期325例(71.3%)。治疗方式包括:单纯手术治疗或术后放疗计划未完成者84例,术前计划性放化疗+手术49例,手术+术后放疗/放化疗314例,诱导化疗+手术+术后放疗9例。原发灶切除方式包括:激光手术5例;部分喉部分下咽切除74例,其中48例(64.9%)为环状软骨上次全喉切除环舌吻合术;全喉部分下咽切除90例;全喉全下咽及颈段食管切除226例;全喉全下咽全食管切除61例。主要修复方式包括游离空肠移植226例,胃上提代下咽食管61例,胸大肌肌皮瓣32例。所有患者均行咽后淋巴清扫术,入院及随访期间均行高清胃镜检查。采用SPSS 24.0软件对数据进行分析。结果:患者3年生存率为59.8%,5年生存率为49.5%;3年肿瘤特异性生存率为69.0%,5年肿瘤特异性生存率为58.8%。咽后淋巴结转移率为12.7%,下咽癌同时及异时多原发癌的患者共132例(28.9%)。多因素回归分析,T3-4期病变、伴有颈部淋巴结转移、伴有咽后淋巴结转移以及手术联合术后放/化疗的综合治疗为影响患者预后的独立因素(P值均<0.05)。随访截至2022年4月30日,共死亡221例,其中远处转移患者共109例(49.3%),是死亡的主要原因。结论:通过对下咽癌的术前评估、手术切除与修复方式的改进、主动的咽后淋巴清扫及第二原发癌的全程干预,可提高下咽癌的疗效。Objective To retrospectively analyse the efficacy of surgerical comprehensive treatment for hypopharyngeal cancer.Methods Four hundred and fifty-six cases of hypopharyngeal squamous cell carcinoma treated from Jan 2014 to Dec 2019 were analyzed retrospectively,including 432 males and 24 females,aged 37-82 years old.There were 328 cases of pyriform sinus carcinoma,88 cases of posterior pharyngeal wall carcinoma,and 40 cases of postcricoid carcinoma.According to American Joint Committe on Cancer(AJCC)2018 criteria,420 cases were of stageⅢorⅣ;325 cases were of T3 or T4 stage.Treatment methods included surgery alone in 84 cases,preoperative planned radiotherapy plus surgery in 49 cases,surgery plus adjuvant radiotherapy or concurrent chemoradiotherapy in 314 cases,and inductive chemotherapy plus surgery and adjuvant radiotherapy in 9 cases.The primary tumor resection methods included transoral laser surgery in 5 cases,partial laryngopharyngectomy in 74 cases,of them 48 cases(64.9%)presented with supracricoid hemilaryngopharyngectomy,total laryngectomy with patial pharyngectomy in 90 cases,total laryngopharyngectomy or with cervical esophagectomy in 226 cases,and total laryngopharyngectomy with total esophagectomy in 61 cases.Among 456 cases,226 cases received reconstruction surgery with free jejunum transplantation,61 cases with gastric pull-up,and 32 cases with pectoralis myocutaneous flaps.All patients underwent retropharyngeal lymph node dissection,and high-definition gastroscopy was performed during admission and follow-up.SPSS 24.0 software was used to analyze the data.Results The 3-year and 5-year overall survival rates were respectively 59.8%,and 49.5%.The 3-year and 5-year disease specific survival rates were respectively 69.0%and 58.8%.Total metastasis rate of retropharyngeal lymph nodes was 12.7%.A total of 132 patients(28.9%)suffered from simultaneous and metachronous multiple primary carcinoma of the hypopharynx.Multivariate Logistic regression analysis showed that T3-4 disease,cervical lymph node met

关 键 词：下咽肿瘤 癌 鳞状细胞 手术 综合治疗 预后 

分 类 号：R739.63[医药卫生—肿瘤]