喉癌术后复发再治疗的研究

发布时间：2018-10-22 16:25

【摘要】：目的:探讨喉癌术后复发的治疗效果。方法:回顾性分析大连医科大学附属第一医院耳鼻咽喉科自1998—2009年收治的742例喉癌患者中45例术后复发病人的临床资料。其中声门型复发29例，声门上型复发14例，跨声门型复发2例;局部复发22例，颈部复发15例，远处转移8例。全部病例均有随访，失访两例，以死亡计。并应用Kaplan-Meier法进行生存分析。结果:喉癌患者术后的复发部位包括局部复发、颈部复发及远处转移；喉鳞癌复发的时间为3-119个月，中位时间为18个月，术后一年复发29例，术后二年复发11例，术后三年以上复发5例，本组资料术后复发的时间特点与国内资料相符；Kaplan-Meier法进行生存分析结果表明，喉癌术后喉复发癌外科挽救治疗后的总3、5年累及生存率分别为46.7%和17.8%，复发率为6.1%，较国内数据低，此结果与我科部分患者多采用术后放疗的治疗方式有关。结论:喉癌术后一年内复发最为多见，应重视术式的恰当选择和颈部淋巴结转移的正确处理，临床上应密切随访，定期行影像学检查，力争早期发现复发灶，及时对喉复发癌行外科挽救手术，以期达到较好疗效，本组3年生存率可到达46.7%；局部复发灶的手术方式以全喉切除为主，颈部复发以扩大根治性颈清扫术为主；复发癌灶多有深部及喉外组织侵犯，手术难度大，组织缺损多，常需要修复，预后较差；对于晚期复发癌不能行手术者，可辅以放射、化学治疗及其他治疗；对侵及食管，影响进食的患者可尽早做胃造瘘手术，，使这类晚期病人带瘤生存能获得一定的生存时间。
[Abstract]:Objective: to investigate the therapeutic effect of postoperative recurrence of laryngeal carcinoma. Methods: the clinical data of 742 patients with laryngeal cancer treated in Department of Otolaryngology, first affiliated Hospital of Dalian Medical University from 1998 to 2009 were retrospectively analyzed. There were 29 cases of glottic recurrence, 14 cases of supraglottic recurrence, 2 cases of transglottic recurrence, 22 cases of local recurrence, 15 cases of cervical recurrence and 8 cases of distant metastasis. All cases were followed up, two cases were lost, in terms of death. The survival analysis was carried out by Kaplan-Meier method. Results: the recurrence sites of laryngeal carcinoma included local recurrence, cervical recurrence and distant metastasis, the recurrence time of laryngeal squamous cell carcinoma was 3-119 months, the median time was 18 months, 29 cases recurred one year after operation, and 11 cases recurred two years after operation. There were 5 cases of recurrence more than 3 years after operation. The time characteristics of recurrence were consistent with the domestic data, and the survival analysis by Kaplan-Meier method showed that, The total 3- and 5-year survival rates were 46.7% and 17.8%, respectively, and the recurrence rate was 6.1, which was lower than that in China. The results were related to the treatment of postoperative radiotherapy in some patients in our department. Conclusion: the recurrence of laryngeal carcinoma is the most common in one year after operation. We should pay attention to the proper choice of operation methods and the correct management of cervical lymph node metastasis. We should follow up closely in clinical practice and make regular imaging examination in order to find recurrence early. The 3-year survival rate of this group can reach 46.7%, the operative mode of local recurrence is total laryngectomy and neck recurrence is extended radical neck dissection. The recurrent cancer foci have the invasion of deep and extralaryngeal tissue, the operation is difficult, the tissue defect is many, often need to repair, and the prognosis is poor. For the patients with advanced recurrent cancer who can not be operated on, they can be supplemented with radiotherapy, chemotherapy and other treatment, and the esophagus is invaded. Patients with food intake may have gastrostomy as early as possible, so that the patients with tumor can get a certain survival time.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.65

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