梨状窝外侧壁癌的治疗体会
리상와외측벽암적치료체회
Treatment of pyriform sinus carcinoma involving the lateral wall
  • 万方数据
    中华耳鼻咽喉头颈外科杂志 중화이비인후두경외과잡지
    CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
    2013年 4期 300-306 ,共7页

    宋西成%张庆泉%王丽%孙岩%张华%陈秀梅%王强%柳忠禄%宋轶鹏

    송서성%장경천%왕려%손암%장화%진수매%왕강%류충록%송질붕

    下咽肿瘤%癌,鳞状细胞%咽切除术%预后 下嚥腫瘤%癌,鱗狀細胞%嚥切除術%預後
    하인종류%암,린상세포%인절제술%예후
    Hypopharyngeal neoplasms%Carcinoma,squamous cell%Pharyngectomy%Prognosis
    目的 探讨梨状窝外侧壁癌的临床特点、治疗措施及疗效.方法 回顾性分析1997年6月至2009年6月77例梨状窝外侧壁癌患者的临床资料.根据2002年UICC分期标准,Ⅰ期8例,Ⅱ期10例,Ⅲ期32例,Ⅳ期27例.将病例分成两组,一组单纯行放射治疗(R组)17例,另一组为手术+放疗(SR组)60例,放射剂量50 ～ 75 Gy.SR组根据病变情况分别采取舌骨区和咽侧手术入路切除肿瘤,术后通过局部拉拢缝合、带状肌肌筋膜瓣、胸大肌肌皮瓣、联合裂层皮片或异种(牛)脱细胞真皮基质修复膜等方式行组织缺损修复和咽喉功能重建.结果 R组17例放疗结束后15例原发灶及颈部转移淋巴结消失；1例N3患者颈部淋巴结缩小,局部未控制,7个月后死于全身转移；1例N2患者,放疗满疗程后颈部肿物显著缩小,PET-CT和穿刺活检未发现癌变,半年后肿物再次长大,并于11个月后死于颈部大出血.SR组所有修复组织及修复材料成活,术后伤口感染2例,发生咽瘘2例.全组患者保留了全部喉功能.SR组全部病例术后12 ～30 d恢复经口进食,平均恢复进食时间15.6 d.全组病例3年、5年生存率分别为59.1％和41.4％；Ⅰ期+Ⅱ期病例SR组和R组3年、5年生存率分别为63.6％、53.0％和66.7％、50.0％,两者相比差异无统计学意义(x2=0.021,P=0.884)；Ⅲ期+Ⅳ期病例SR组和R组3年、5年生存率分别为63.9％、43.7％和16.4％、0,两者相比差异有统计学意义(x2=20.496,P=0.000)；全部病例SR组和R组3年、5年生存率分别为63.6％、45.8％和41.5％、24.9％,两者相比差异有统计学意义(x2=4.644,P=0.031).结论 梨状窝外侧壁癌多在黏膜表面或黏膜下弥漫生长,浸润生长者容易侵犯甲状软骨板向外扩展.早期病例放疗可以获得较好的治疗效果,晚期病例具备手术适应证者应采取手术+放疗的综合治疗措施.对手术患者采取适合的手术入路和修复方式,可彻底切除肿瘤,并能保留重建较好的咽喉功能.
    목적 탐토리상와외측벽암적림상특점、치료조시급료효.방법 회고성분석1997년6월지2009년6월77례리상와외측벽암환자적림상자료.근거2002년UICC분기표준,Ⅰ기8례,Ⅱ기10례,Ⅲ기32례,Ⅳ기27례.장병례분성량조,일조단순행방사치료(R조)17례,령일조위수술+방료(SR조)60례,방사제량50 ～ 75 Gy.SR조근거병변정황분별채취설골구화인측수술입로절제종류,술후통과국부랍롱봉합、대상기기근막판、흉대기기피판、연합렬층피편혹이충(우)탈세포진피기질수복막등방식행조직결손수복화인후공능중건.결과 R조17례방료결속후15례원발조급경부전이림파결소실；1례N3환자경부림파결축소,국부미공제,7개월후사우전신전이；1례N2환자,방료만료정후경부종물현저축소,PET-CT화천자활검미발현암변,반년후종물재차장대,병우11개월후사우경부대출혈.SR조소유수복조직급수복재료성활,술후상구감염2례,발생인루2례.전조환자보류료전부후공능.SR조전부병례술후12 ～30 d회복경구진식,평균회복진식시간15.6 d.전조병례3년、5년생존솔분별위59.1％화41.4％；Ⅰ기+Ⅱ기병례SR조화R조3년、5년생존솔분별위63.6％、53.0％화66.7％、50.0％,량자상비차이무통계학의의(x2=0.021,P=0.884)；Ⅲ기+Ⅳ기병례SR조화R조3년、5년생존솔분별위63.9％、43.7％화16.4％、0,량자상비차이유통계학의의(x2=20.496,P=0.000)；전부병례SR조화R조3년、5년생존솔분별위63.6％、45.8％화41.5％、24.9％,량자상비차이유통계학의의(x2=4.644,P=0.031).결론 리상와외측벽암다재점막표면혹점막하미만생장,침윤생장자용역침범갑상연골판향외확전.조기병례방료가이획득교호적치료효과,만기병례구비수술괄응증자응채취수술+방료적종합치료조시.대수술환자채취괄합적수술입로화수복방식,가철저절제종류,병능보류중건교호적인후공능.
    Objective To present and discuss the clinical features,treatment,and efficacy of pyriform sinus carcinoma involving the lateral wall.Methods Seventy-seven patients with pyriform sinus cancer involving the lateral wall (stage Ⅰ 8,stage Ⅱ 10,stage Ⅲ 32,stage Ⅳ 27,according to UICC 2002 staging) were treated from Jun 1997 to Jun 2009 in the department of otorhinolaryngology head and neck surgery,Yuhuangding Hospital.The patients were divided into two groups:Group one 17 cases,simply underwent radiation therapy (R group) ; Group two 60 cases underwent surgery plus postoperative radiation (SR group).All patients underwent radiotherapy 50-75 Gy.In SR group,hyoid area and lateral pharyngeal approaches were taken according to the lesions for resection.To repair the defects and reconstruct the functions of larynx and pharynx,regional roping in suture,fascial flap/muscular-fascial of strap muscles,glosso-flap,musculocutaneous flap of major pectoral muscle,joint split graft or heterologous (bovine) acellular dermal matrix were used respectively.Results In group R,the primary tumor and neck lymph node metastasis disappeared at the end of radiotherapy in 15 cases.For one case,the N3 cervical lymph nodes shrank,but failed in local control and died of systemic metastases after 7 months.For another case,the N2 neck lymph nodes significantly reduced after the full course of radiation,PET-CT and biopsy did not find the cancer,but the tumor grew again after 6 months,and died of a neck bleeding 11 months later.All repairing materials used were alive in SR group.Two cases developed postoperative wound infection,and 2 cases suffered from pharyngeal fistula.All patients retained laryngeal functions,and all patients in SR group recovered diet 12-30 days,the mean time was 15.6 days.Three and 5 year survival rates for all 77 patients were 59.1％ and 41.4％.For stage Ⅰ + stage Ⅱcases in SR group and R group,3 and 5 year survival rates were 63.6％,53.0％ and 66.7％,50.0％ respectively.There was no significant difference between the two groups (x2=0.021,P=0.884).For cases of stage Ⅲ + stage Ⅳ of the SR group and R group,3 and 5 year survival rates were 63.9％,43.7％,16.4％,and 0.There was a very significant difference (x2 =20.496,P =0.000) ; all cases in SR group and in R group for 3,5-year survival rates were 63.6％,45.8％,41.5％,and 24.9％ respectively.There was also a significant stastical difference (x2 =4.644,P =0.031).Conclusions Pyriform sinus carcinoma involving the lateral wall is characterized with scattered growth on the surface of mucous or submucously,tending to invade lamina cartilaginis thyroidea.Simple radiotherapy can get better therapeutic effect for early stage cases.The comprehensive therapy measures should be taken in advanced cases,especially those with surgical indications should be taken to surgery plus radiotherapy.For the purpose of excising the tumor thoroughly and preserving good laryngeal functions,proper operative approaches and ways of repairing should be selected.
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