Li W M, Wei D M, Qian Y, Cao S D, Xu Y, Liu D Y, Lei D P, Pan X L
Department of Otorhinolaryngology Head and Neck Surgery, Qilu Hospital of Shandong University; Key Laboratory of Otorhinolaryngology, National Health Commission(Shandong University), Jinan 250012, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 May 7;53(5):339-345. doi: 10.3760/cma.j.issn.1673-0860.2018.05.003.
To report the experience in comprehensive surgical treatment of pyriform sinus carcinoma via the paraglottic space approach. Three hundred and thirty-five cases with pyriform sinus carcinoma (according to UICC 2012 criteria, stage Ⅰ, 12 cases; Ⅱ, 36; Ⅲ, 79; Ⅳ, 208; T1, 26; T2, 139; T3, 121; T4, 49; cN0, 83; cN1, 61; cN2a-b, 118; cN2c, 71; cN3, 2) treated between 2006 and 2013 were retrospectively reviewed. There were 323 males and 12 females. Age aged from 36 to 80 years old with a median of 60 years old. There was no case with distant metastasis. All patients received modified neck dissection, including unilateral in 240 patients and bilateral in 95 patients. Pharyngoesophageal defects were reconstructed with directly suture in 246 cases, pectoralis major musculocutaneous flaps in 74 cases, and laryngotracheal flaps in 15 cases. Three hundred and nineteen patients received postoperative radiotherapy (55-65 Gy). The overall 3 and 5 year survival rates were 68.6% (230/335) and 52.1%(139/267), respectively. The cervical lymph node metastases were found in 265 (79.1%) patients. Pathologic findings showed that all patients had squamous cell carcinoma. Laryngeal functions (voice, respiration and deglutition) were completely restored in 277 (82.7%) patients. The oncological efficacy of surgery via the paraglottic space approach is sure for pyriform sinus carcinoma, especially suitable for the early and medium-term lesions. The function of the larynx can retain after surgery, with the decreased incidences of cough and pharynx fistula.
报告经声门旁间隙入路综合手术治疗梨状窝癌的经验。回顾性分析2006年至2013年间收治的335例梨状窝癌患者（根据2012年UICC标准，Ⅰ期12例；Ⅱ期36例；Ⅲ期79例；Ⅳ期208例；T1 26例；T2 139例；T3 121例；T4 49例；cN0 83例；cN1 61例；cN2a - b 118例；cN2c 71例；cN3 2例）。其中男性323例，女性12例。年龄36至80岁，中位年龄60岁。无远处转移病例。所有患者均接受改良颈清扫术，其中单侧清扫240例，双侧清扫95例。246例患者采用直接缝合修复咽食管缺损，74例采用胸大肌肌皮瓣修复，15例采用喉气管瓣修复。319例患者接受术后放疗（55 - 65 Gy）。总体3年和5年生存率分别为68.6%（230/335）和52.1%（139/267）。265例（79.1%）患者发现颈部淋巴结转移。病理结果显示所有患者均为鳞状细胞癌。277例（82.7%）患者的喉功能（发声、呼吸和吞咽）完全恢复。经声门旁间隙入路手术治疗梨状窝癌的肿瘤学疗效确切，尤其适用于早中期病变。术后可保留喉功能，咳嗽和咽瘘发生率降低。
