Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medical Center, Chicago, IL, USA.
Head Neck. 2012 Feb;34(2):254-9. doi: 10.1002/hed.21729. Epub 2011 Mar 7.
Patients with upper aerodigestive tract tumors can have development of airway compromise both before and during chemoradiotherapy (CRT). Tracheotomy is the classic method for securing a safe airway, but tumor debulking may also be used.
This was a retrospective review of locoregionally advanced tumors of the base of tongue, larynx, or hypopharynx undergoing CRT between 1995 and 2007.
Forty-two of the 109 patients presented with signs or symptoms of airway obstruction. Of these, 28 underwent tracheotomy before CRT, and 11 had tumor debulking. Two of the 11 patients who underwent debulking required tracheotomy within 1 year after CRT for persistent edema and fibrosis. Larynx tumors were more likely to require tracheotomy or debulking than other tumors (p = .01).
Debulking is a safe and effective alternative to tracheotomy in select patients with tumor-related airway obstruction before CRT. Patients who undergo debulking should be monitored closely for recurrence of airway compromise during and after CRT.
上呼吸道消化道肿瘤患者在放化疗（CRT）前后可能会出现气道阻塞。气管切开术是确保安全气道的经典方法，但也可以进行肿瘤切除术。
这是对 1995 年至 2007 年间接受 CRT 的舌根、喉或下咽局部晚期肿瘤患者进行的回顾性研究。
109 例患者中有 42 例出现气道阻塞的体征或症状。其中，28 例在 CRT 前进行了气管切开术，11 例进行了肿瘤切除术。在接受切除术的 11 例患者中，有 2 例在 CRT 后 1 年内因持续水肿和纤维化需要进行气管切开术。与其他肿瘤相比，喉肿瘤更需要气管切开术或切除术（p =.01）。
在 CRT 前有肿瘤相关气道阻塞的选择患者中，肿瘤切除术是一种安全有效的气管切开术替代方法。接受切除术的患者应在 CRT 期间和之后密切监测气道阻塞的复发情况。
