CAJ | 학술논문

目的探讨下咽后壁鳞状细胞癌患者保留喉及下咽功能不同修复方法的效果.方法 2004年10月至2013年5月13例下咽后壁鳞状细胞癌患者进行喉功能保留的外科治疗.13例患者中原发灶T2期6例,T3期7例.采用喉及下咽部分切除手术,Ⅰ期采用咽后壁旷置或游离组织瓣修复喉及下咽缺损.13例患者中3例行游离前臂皮瓣修复,1例行游离股前外侧皮瓣修复,1例行锁骨上皮瓣修复,1例行颏下瓣修复,1例行游离植皮修复下咽及部分喉,6例咽后壁旷置.2例患者为放疗后复发行挽救手术,2例术前同步放化疗,2例未行术后放疗,其余7例初治患者均行术后放疗,平均剂量55 Gy.采用Kaplan-Meier法计算患者生存率.结果本组患者术后随访3～67个月,中位随访20个月.3年总生存率和疾病特异性相关生存率达51.6％.5例次(5/13)患者发生手术并发症,包括:咽瘘3例次,伤口感染1例次,颈部积液1例次.13例全部拔除气管套管和完全恢复经口进食.结论下咽后壁鳞状细胞癌患者可视缺损大小采用不同的修复技术,保留和重建喉功能,在保证生存率的同时提高患者生活质量.
목적 탐토하인후벽린상세포암환자보류후급하인공능불동수복방법적효과.방법 2004년10월지2013년5월13례하인후벽린상세포암환자진행후공능보류적외과치료.13례환자중원발조T2기6례,T3기7례.채용후급하인부분절제수술,Ⅰ기채용인후벽광치혹유리조직판수복후급하인결손.13례환자중3례행유리전비피판수복,1례행유리고전외측피판수복,1례행쇄골상피판수복,1례행해하판수복,1례행유리식피수복하인급부분후,6례인후벽광치.2례환자위방료후복발행만구수술,2례술전동보방화료,2례미행술후방료,기여7례초치환자균행술후방료,평균제량55 Gy.채용Kaplan-Meier법계산환자생존솔.결과 본조환자술후수방3～67개월,중위수방20개월.3년총생존솔화질병특이성상관생존솔체51.6％.5례차(5/13)환자발생수술병발증,포괄:인루3례차,상구감염1례차,경부적액1례차.13례전부발제기관투관화완전회복경구진식.결론 하인후벽린상세포암환자가시결손대소채용불동적수복기술,보류화중건후공능,재보증생존솔적동시제고환자생활질량.
Objective To study the larynx preservation after resection of posterior hypopharygeal wall squamous cell carcinoma.Methods Retrospective review of 13 patients who underwent resection of posterior hypopharyngeal wall squamous cell carcinoma from October 2004 to May 2013.Of 13 patients,6 had T2 lesions and 7 had T3 lesions.Two underwent salvage surgery,2 with concurrent chemoradiotherapy before surgery,2 with no radiotherapy and other 7 with postoperative radiotherapy (55 Gy).Repair with flap was not required in 6 cases,and repair with free skin graft was performed in 1 case,submental flap for 1 case,supraclavicular artery flap for 1 case,radial forearm flaps for 3 cases,and anterolateral thigh flap for 1 case for laryngopharyngeal reconstruction.Results The 3 year over all survival rate and disease-specific survival rate were 51.6％.Surgical complications included 3 fistula,1 wound infection,and 1 wound effusion.The rate of decanulation was 100％,and all patients were with oral feeding.Conclusion Different flaps can be used to reconstruct a functional larynx after resection of posterior hypopharyngeal wall squamous cell carcinoma,patients having good quality of life.