中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2011年
6期
495-500
,共6页
邸斌%李晓明%尚耀东%宋琦%陶振峰%成继民
邸斌%李曉明%尚耀東%宋琦%陶振峰%成繼民
저빈%리효명%상요동%송기%도진봉%성계민
喉肿瘤%癌%鳞状细胞%放射疗法%挽救疗法%喉切除术%预后
喉腫瘤%癌%鱗狀細胞%放射療法%輓救療法%喉切除術%預後
후종류%암%린상세포%방사요법%만구요법%후절제술%예후
Laryngeal neoplasms%Carcinoma squamous cell%Radiotherapy%Salvage therapy%Laryngectomy%Prognosis
目的 探讨喉癌单纯放疗后原发灶及颈部淋巴结残留和复发患者实施挽救性手术治疗的远期疗效及预后影响因素.方法 对72例患者进行回顾性分析,包括:放疗后原发灶及颈部复发22例,放疗后原发灶及颈部残留50例.均实施喉全切除术+经典性颈清扫术或改良性颈清扫术.应用Kaplan-Meier法计算手术后总生存率,采用Log-rank检验单因素分析临床因素对预后的影响,对影响生存率的有关因素采用Cox模型进行多因素分析.结果 实施挽救性手术的并发症发生率41 7%,其中咽瘘发生率20 8%.术后5年内肿瘤再次复发率34 7%(25/72),远处转移率22 2%(16/72),第二原发癌发生率6.9%(5/72).术后的3、5年生存率为45 8%和36 1%.复发癌N分期(rN)、肿瘤放疗失败类型、切缘情况、浸润深度、有无颈淋巴转移、淋巴结包膜侵犯和颈部非淋巴结构侵犯与患者的预后有关(P值均<0.05).多因素分析结果表明:肿瘤放疗失败类型、切缘情况、肿瘤浸润深度是影响患者预后的独立危险因素.结论 喉癌患者单纯放疗失败后应以手术挽救为主.对于术前及术中发现肿瘤侵犯肌肉及软骨的病例,特别是对根治性放疗效果不佳而肿瘤残留者,术中应充分估计肿瘤的范围,并冰冻病理检查切缘,以保证足够的安全切缘,提高挽救性手术的成功率.
目的 探討喉癌單純放療後原髮竈及頸部淋巴結殘留和複髮患者實施輓救性手術治療的遠期療效及預後影響因素.方法 對72例患者進行迴顧性分析,包括:放療後原髮竈及頸部複髮22例,放療後原髮竈及頸部殘留50例.均實施喉全切除術+經典性頸清掃術或改良性頸清掃術.應用Kaplan-Meier法計算手術後總生存率,採用Log-rank檢驗單因素分析臨床因素對預後的影響,對影響生存率的有關因素採用Cox模型進行多因素分析.結果 實施輓救性手術的併髮癥髮生率41 7%,其中嚥瘺髮生率20 8%.術後5年內腫瘤再次複髮率34 7%(25/72),遠處轉移率22 2%(16/72),第二原髮癌髮生率6.9%(5/72).術後的3、5年生存率為45 8%和36 1%.複髮癌N分期(rN)、腫瘤放療失敗類型、切緣情況、浸潤深度、有無頸淋巴轉移、淋巴結包膜侵犯和頸部非淋巴結構侵犯與患者的預後有關(P值均<0.05).多因素分析結果錶明:腫瘤放療失敗類型、切緣情況、腫瘤浸潤深度是影響患者預後的獨立危險因素.結論 喉癌患者單純放療失敗後應以手術輓救為主.對于術前及術中髮現腫瘤侵犯肌肉及軟骨的病例,特彆是對根治性放療效果不佳而腫瘤殘留者,術中應充分估計腫瘤的範圍,併冰凍病理檢查切緣,以保證足夠的安全切緣,提高輓救性手術的成功率.
목적 탐토후암단순방료후원발조급경부림파결잔류화복발환자실시만구성수술치료적원기료효급예후영향인소.방법 대72례환자진행회고성분석,포괄:방료후원발조급경부복발22례,방료후원발조급경부잔류50례.균실시후전절제술+경전성경청소술혹개량성경청소술.응용Kaplan-Meier법계산수술후총생존솔,채용Log-rank검험단인소분석림상인소대예후적영향,대영향생존솔적유관인소채용Cox모형진행다인소분석.결과 실시만구성수술적병발증발생솔41 7%,기중인루발생솔20 8%.술후5년내종류재차복발솔34 7%(25/72),원처전이솔22 2%(16/72),제이원발암발생솔6.9%(5/72).술후적3、5년생존솔위45 8%화36 1%.복발암N분기(rN)、종류방료실패류형、절연정황、침윤심도、유무경림파전이、림파결포막침범화경부비림파결구침범여환자적예후유관(P치균<0.05).다인소분석결과표명:종류방료실패류형、절연정황、종류침윤심도시영향환자예후적독립위험인소.결론 후암환자단순방료실패후응이수술만구위주.대우술전급술중발현종류침범기육급연골적병례,특별시대근치성방료효과불가이종류잔류자,술중응충분고계종류적범위,병빙동병리검사절연,이보증족구적안전절연,제고만구성수술적성공솔.
Objective To investigate survival outcomes of salvage surgery preformed for laryngeal squamous cell carcinoma that recurred or progressed after radiotherapy alone. Methods A review of 72 patients who underwent salvage laryngectomy for laryngeal cancer failed in initial radiation therapy between 1996 and 2005 was performed. The tumor persistence occurred in 50 cases and recurrence in 22 cases. All patients received salvage total laryngectomy and radical neck dissection. Survival analysis was performed by using Kaplan-Meier method, Log-rank test and Cox proportional hazard model. Results Thirty patients developed a postoperative complication after salvage surgery. Pharyngocutaneous fistula occurred in 15 (20. 8 % ) patients. During 5 years after salvage surgery, the rates of tumor recurrence, distant metastasis and second malignancy were 34.7% , 22. 2% and 6. 9% , respectively. Kaplan-Meier analysis showed that overall 3 year and 5 year survival rates of those patients after operation were 45. 8% and 36. 1% ,respectively. Univariate analysis indicated that N restage, tumor persistence/recurrences after radiotherapy,surgical margin status, level of tumor invasion, pathologic N stage, extracapsular nodal spread and invasion of nonlymphatic structures were significantly associated with overall survival. Multivariate analysis showed the most significant prognostic factors were tumor persistence or recurrence after radiotherapy, surgical margin status and level of tumor invasion. Conclusions Surgical salvage remains the gold standard for management after failure of initial radiation therapy. The extent of tumor invasion must be assessed sufficiently before operation, and the surgical margin status must be identified in operation by using a frozen sectioning approach, especially in patients with tumor invasion to muscle/cartilage and tumor persistence after radiotherapy.