声门型喉癌术后喉内第二原发癌的发生及其病因学研究

发布时间：2018-02-22 21:00

本文关键词： 声门型喉癌复发第二原发癌　出处：《安徽医科大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的探讨喉内第二原发癌与声门型喉癌术后复发的关系及声门型喉癌术后复发的原因。方法随访2001年10月至2009年10月的单侧声门型喉癌T1-T3期的病例。术后超过3年的的患者,统计复发部位为对应残喉的比例;对于术后1-3年病例,行电子喉镜检查,对侧声带可疑病例者行活检;现病例,术中同时行对侧声带前中1/3处活检进行病理学检查。对术后1-3年及现病例的患者对侧声带癌变复发以及有癌前病变的病例与对侧声带无病变的病例进行病因分析。结果术后随访3-8年的患者84例,共复发21例,其中原发部位局部复发10例,颈部复发5例,原发部位以外的对侧半喉复发6例,该组对侧半喉复发率为7.2%,占术后总复发者28.6%;术后1-3年55例,术后不同部位复发共6例,其中对侧半喉复发1例,复发率为1.8%,占术后总复发者16.6%,术后1-3年55例中对侧声带有不典型增生12例;现病例30例龴2008年10月至2009年10月共收集新住院单侧声门型喉癌病例㖞,对侧声带同时有癌变者2例,不典型增生者7例,无病变者21例。术后1-3年病例中,家族有无遗传史、患者术后是否吸烟、放疗以及有无食管反流对于对侧声带是否发生癌变或癌前病变有一定的影响,经统计学分析差异皆有显著性(P分别为0.006、0.003、0.029、0.020);术前不同T分期对于对侧声带是否发生癌变或癌前病变无统计学意义(P=0.980)。现病例中,家族有无遗传史、患者术前是否吸烟、饮酒以及有无喉咽反流对于对侧声带是否发生癌变或癌前病变有一定的影响,经统计学分析差异皆有显著性(P分别为0.034、0.029、0.039、P=0.008);术前不同T分期对于对侧声带是否发生癌变或癌前病变无统计学意义(P=0.841)。结论喉内对侧半喉复发(喉内第二原发癌)是声门型喉癌复发的重要原因之一,随着随访时间的延长,复发的几率增大。家族有遗传史、术后吸烟饮酒、食管反流等是术后对侧半喉复发的重要致病因素。
[Abstract]:Objective to investigate the relationship between intralaryngeal second primary carcinoma and postoperative recurrence of glottic laryngeal carcinoma and the causes of postoperative recurrence of glottic laryngeal carcinoma. Methods patients with unilateral glottic carcinoma of stage T1-T3 were followed up from October 2001 to October 2009. The recurrence sites of the patients more than 3 years after operation were counted as the proportion of residual larynx, and the laryngoscopy was performed for 1-3 years after operation. Biopsy of suspected cases of contralateral vocal cords; present case, Pathological examination was performed at 1/3 biopsy sites of the contralateral vocal cord at the same time during the operation. Etiological analysis was carried out in patients with recurrence of contralateral vocal cord cancer and cases with precancerous lesions and cases with no lesion of contralateral vocal cord in 1-3 years and present cases. Results 84 cases were followed up for 3 to 8 years, 21 cases recurred, including 10 cases of local recurrence of primary site, 5 cases of neck recurrence and 6 cases of contralateral hemilarynx recurrence outside the primary site. The recurrence rate of contralateral half larynx was 7.2, accounting for 28.6% of the total recurrence rate, 55 cases in 1-3 years after operation, 6 cases of recurrence in different parts of the group, and 1 case of recurrence of contralateral half larynx. The recurrence rate was 1.8%, accounting for 16.6% of the total recurrence after operation, 12 cases of contralateral vocal cord dysplasia were found in 55 cases in 1-3 years after operation, 30 cases were present cases? From October 2008 to October 2009, a total of hospitalized cases of unilateral glottic laryngeal carcinoma were collected. , 2 cases of contralateral vocal cord carcinogenesis, 7 cases of atypical hyperplasia, 21 cases of no pathological changes. Radiotherapy and esophageal reflux have some effects on the carcinogenesis or precancerous lesion of the contralateral vocal cord. There were significant differences between the two groups (P = 0.006, P = 0.003, P = 0.029, P = 0.020, respectively). There was no significant difference in whether the contralateral vocal cord carcinogenesis or precancerous lesion occurred in different T stages before operation. There was no significant difference between the two groups. In the present case, there was no genetic history in the family and whether the patient smoked before operation. Alcohol consumption and the presence of laryngopharyngeal reflux may have an effect on the carcinogenesis or precancerous lesion of the contralateral vocal cord. There were significant differences between the two groups (P = 0.034, 0.029, 0.039, P 0.008, respectively), and there was no significant difference between different T stages before operation in the development of carcinogenesis or precancerous lesion of the contralateral vocal cord. Conclusion the recurrence of the contralateral half larynx (the second primary carcinoma of the larynx) is one of the important reasons for the recurrence of glottic laryngocarcinoma. With the extension of follow-up time, the recurrence rate increases. Esophageal reflux is an important risk factor for the recurrence of contralateral half larynx.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R739.65

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