65岁以上高龄下咽癌患者的功能保全性手术治疗

发布时间：2018-05-12 04:31

本文选题：咽肿瘤 + 咽切除术　；参考：《临床耳鼻咽喉头颈外科杂志》2015年04期

【摘要】：目的:探讨65岁高龄下咽癌患者喉功能保留手术的疗效。方法:65岁高龄下咽癌患者58例,分为喉功能保留组31例和喉功能未保留组27例。术前均行完善的术前准备,术中肿瘤切除标本送冷冻证实切缘阴性后应用局部缝合、带状肌皮瓣、胸大肌皮瓣、裂层皮片、胃代食管等对缺损进行修复,术后均行根治性放疗。用Kaplan-Meier法计算生存率,用卡方检验比较两组并发症。结果:所有患者3、5年生存率分别为48.3%(28/58)和27.6%(16/58)。喉功能保留组3、5年生存率分别为51.6%(16/31)和29.0%(9/31);喉功能未保留组分别为44.4%(12/27)和25.9%(7/27),3、5年生存率差异均无统计学意义(P0.05)。两组并发症的发生率分别为45.2%(14/31)和40.7%(11/27),差异无统计学意义(P0.05)。结论:高龄下咽癌患者根据其全身状况及肿瘤的侵犯范围选择喉功能保全是可行的,关键是充分做好围手术期处理,正确掌握适应证,提高术中修复技巧。
[Abstract]:Objective: to investigate the effect of laryngeal function preserving surgery in 65 years old patients with hypopharyngeal carcinoma. Methods 58 patients with hypopharyngeal carcinoma aged 65 years were divided into two groups: laryngeal function preservation group (31 cases) and laryngeal function unpreserved group (27 cases). The defect was repaired by local suture, band myocutaneous flap, pectoralis major myocutaneous flap, fissure skin graft, stomach substitute esophagus and so on. Kaplan-Meier method was used to calculate the survival rate and chi-square test was used to compare the complications between the two groups. Results: the 3-and 5-year survival rates of all patients were 48.3 / 58 and 27.6 / 58 respectively. The 3- and 5-year survival rates of laryngeal function retention group were 51.6 / 16 / 31) and 29.0 / 9 / 31g, respectively, while those of non-reserved laryngeal function group were 44.412 / 27) and 25.97 / 27 / 27, respectively. There was no significant difference in 5-year survival rate between the two groups (P 0.05). The incidence of complications in the two groups was 45.2% 14 / 31) and 40.7% / 27% respectively. There was no significant difference between the two groups (P 0.05). Conclusion: it is feasible for the elderly patients with hypopharyngeal carcinoma to select laryngeal function preservation according to their general condition and tumor invasion range. The key is to fully manage the perioperative period, correctly grasp the indications and improve the repair skills during the operation.
【作者单位】：安徽医科大学第一附属医院耳鼻咽喉头颈外科;安徽医科大学附属合肥医院;合肥市第二人民医院耳鼻咽喉科;
【基金】：安徽省教育厅重点项目(No:KJ2012A162)
【分类号】：R739.63

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