摘要
背景与目的:随着人类寿命逐渐延长,老年下咽癌患者也不断增多。老龄下咽癌患者由于体质差,各脏器功能衰退,对手术的耐受力降低,从而增加了手术治疗的复杂性和危险性。本文旨在探讨老年下咽癌患者的手术治疗方法与喉功能保留及其疗效。方法:回顾性分析1996～2001年84例60岁以上老年下咽癌患者行手术治疗的临床资料,其中梨状窝区68例,环后区5例,下咽后壁区11例。保留喉功能57例,不保留喉功能27例。用Kaplan-Meier法计算生存率,用log-rank检验比较两组的生存率。结果:全组患者总的3年生存率为60.7%,5年生存率为53.3%。其中,喉功能保留组3年生存率为63.2%,5年生存率为56.7%;喉功能不保留组3年生存率为55.6%,5年生存率为46.3%。两组生存率无显著性差异(P=0.37,P>0.05)。57例喉功能保留组中,喉功能全恢复(呼吸、发音及吞咽保护)占68.4%(39/57),部分恢复(发音及吞咽保护)占31.6%(18/57)例。结论:对老龄下咽癌(T1-2)患者行手术治疗是安全的、有效的。对T3-4期下咽癌,对侧喉内未受累,病变未达食管入口,无吞咽障碍的老龄患者行喉功能保留手术是可行的。关键是严格把握好手术适应证。
BACKGROUND ＆ OBJECTIVE. The prolongation of life expectancy results in an increasing number of aged patients with hypopharyngeal carcinoma who have poor surgical tolerance because of degenerative organ functions. This study was to explore the surgical methods and preservation of laryngeal function for aged patients with hypopharyngeal carcinoma. METHODS： Clinical data of 84 patients with hypopharyngeal carcinoma who aged above 60 years, treated from 1996 to 2001, were retrospectively reviewed. Of the 84 cases, 68 were originated from pyriform sinus, 5 from postcricoid area, 11 from posterior pharyngeal wall~ 57 patients received partial laryngectomy with laryngeal function preservation, 27 received total laryngectomy. Kaplan-Meier method and log-rank test were used to evaluate the survival rates. RESULTS. The overall 3- and 5-year survival rates were 60.7% and 53.3%, respectively. The 3- and 5-year survival rates of laryngeal function preservation group was not significantly different from those of total laryngectomy group （63.2% vs. 55.6%, P=0.37; 56.7% vs. 46.3%, P〉0.05）. In laryngeal function preservation group, 39 （68.4%） had all functions preserved （voice, respiration, and deglutition）, and 18 （31.6%） partially preserved （voice and deglutition）. CONCLUSION： It is safe and effective to treat aged hypopharyngeal carcinoma patients with surgery, and is possible to preserve laryngeal function in T3-4 stage aged patients who have no involvement of contralateral larynx, no invasion to esophagus, and no deglutition difficulty.
出处
《癌症》
SCIE
CAS
CSCD
北大核心
2005年第11期1372-1375,共4页
Chinese Journal of Cancer
关键词
咽肿瘤/外科学
咽切除术
喉切除术
老年人
Hypopharyngeal neoplasms/surgery
Pharyngectomy
Laryngectomy
Aged
