Li Jia-xi, Li Xing-ru, Sun Gao, Qu Bo, Wang Hui, Dai Song, Guo Zhi-xiang
People's Liberation Army Hospital No. 463 Army Otorhinolaryngology Research Center, Shenyang 110042, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2009 Jun;44(6):469-74.
To evaluate the preservation of laryngeal function hypopharyngeal cancer surgery clinical effectiveness and impact of prognostic factors.
A retrospective analysis in September 1974 - July 2003 treated 45 cases of hypopharyngeal cancer surgery retain the clinical treatment of laryngeal function effect. Among them there were 23 cases of original pyriform sinus cancer, 13 cases of post cricoid cancer and 9 cases of postero pharyngeal wall cancer. Two cases of preoperative radiotherapy, radiotherapy volume of 40-50 Gy; after 32 cases of radiotherapy, radiotherapy dose of 60-70 Gy. Analysis of impact on survival in patients with risk factors.
Forty five cases of preservation of laryngeal function after 88.9% who articulate pronunciation ambiguities were mild 11.1%; 23 cases of tracheostomy tube removal, decannulation rate was 51.1%, all can eat into the cape. Nineteen cases of post-operative complications (42.2%); after 20 cases of cervical lymph node metastasis, accounting for 44.4%. Statistics Kaplan-Meier method in patients with the whole group 5-year survival rate was 53.3%. T1 + T2 and T3 + T4 patients after 5-year survival rates were 66.7% and 43.3%; cN0 and cN1, cN2 group survival rates were 65.2% and 46.7%, 28.6%; pathological differentiation of high, medium and low-group survival rates were 62.3%, 42.1% and 30.8%. Single-factor analysis of survival and whether pre-operative cervical lymph node metastasis and the degree of pathological differentiation (chi2 value of 5.297 and 11.556, P value of 0.021 and 0.003). Multivariate Cox regression analysis showed that the availability of pre-operative cervical lymph node metastasis and pathological effects of the degree of differentiation is an independent risk factor for prognosis (chi2 value of 4.365 and 4.600, P value of 0.041 and 0.032, OR value of 1.151 and 0.610).
Preservation of laryngeal function hypopharyngeal cancer surgery for T1, T2 patients with the best surgical procedures, some of T3, T4 advanced hypopharyngeal cancer can also be used to retain the operation of laryngeal function; and preservation of laryngeal function can not affect the prognosis of patients with.
评估下咽癌手术保留喉功能的临床疗效及影响预后的因素。
回顾性分析1974年9月至2003年7月收治的45例下咽癌手术保留喉功能的临床治疗效果。其中原发梨状窝癌23例，环状软骨后癌13例，下咽后壁癌9例。2例术前放疗，放疗量40 - 50 Gy；32例术后放疗，放疗剂量60 - 70 Gy。分析影响患者生存的危险因素。
45例保留喉功能者术后发音清晰度88.9%轻度含糊，11.1%正常；23例拔除气管套管，拔管率51.1%，均能经口进食。术后并发症19例（42.2%）；术后颈部淋巴结转移20例，占44.4%。采用Kaplan - Meier法统计全组患者5年生存率为53.3%。T1 + T2和T3 + T4患者5年生存率分别为66.7%和43.3%；cN0和cN1、cN2组生存率分别为65.2%、46.7%、28.6%；病理分化高、中、低组生存率分别为62.3%、42.1%和30.8%。单因素分析生存与术前颈部淋巴结有无转移及病理分化程度有关（χ2值分别为5.297和11.556，P值分别为0.021和0.003）。多因素Cox回归分析显示术前颈部淋巴结转移情况及病理分化程度是影响预后的独立危险因素（χ2值分别为4.365和4.600，P值分别为0.041和0.032，OR值分别为1.151和0.610）。
下咽癌手术保留喉功能对T1、T2患者是最佳手术方式，部分T3、T4期进展期下咽癌也可采用保留喉功能的手术方式；且保留喉功能不影响患者预后。
