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摘要: 目的: 总结分析下咽癌的临床特征、治疗效果及预后影响因素。方法: 回顾性分析2008-01-2012-12期间我院耳鼻咽喉科收治的下咽癌97例患者临床病例资料;梨状窝型75例,咽后壁型16例,环后型6例。手术方式包括下咽部分切除术21例(21.6%),部分喉切除加下咽部分切除7例(7.2%),全喉加下咽部分切除术53例(54.6%),全喉全下咽切除加胃上提胃咽吻合术12例(12.4%),全喉全下咽切除加空肠代食道修补术4例(4.1%)。61例术后于肿瘤科进行放疗。采用χ2检验行计数资料分析,采用寿命表法计算生存率,采用Kaplan-Meier法进行生存分析,并行Log-rank检验。采用Cox回归模型对影响患者预后因素行多因素分析。结果: 本组患者随访率为90.7%。全部患者1年生存率为76.0%,3年生存率为56.0%,术后病理颈部淋巴结转移率为71.1%,隐匿性淋巴结转移占19.6%。术后局部复发率为21.6%。患者死亡的主要原因包括:颈部淋巴结转移7例(21.9%),局部复发12例(37.5%),远处转移10例(31.3%)等。单因素分析显示肿瘤的大小(P<0.01)以及肿瘤的T分期(P<0.05)对生存预后有影响,Cox回归模型多因素分析未发现影响患者预后的独立危险因素。结论: 下咽癌早期不易发现,术后极易发生复发及转移,慎重选择病灶切除术式及颈清扫方式,辅助术后放射治疗是主要的治疗策略。咽后壁型下咽癌较另外两型下咽癌更易出现术后的复发及转移,治疗创伤较大,应引起重视。Abstract: Objective: Study the clinical characteristics, treatment results and prognostic factors of hypopharyngeal carcinoma.Method: A retrospective analysis was performed of 97 hypopharyngeal cases that were treated in Department of Otolaryngology of our hospital from January 2008 to December 2012.93 cases of them are male patients,and 4 cases are female patients.The tumors are originated from pyriform sinus(75 cases), posterior pharyngeal wall (16 cases) and postcricoid area (6 cases). Of the 97 patients,21 patients were treated with partial hypopharynx resection (21.6%), 7 were treated with partial laryngectomy+partial hypopharynx resection (7.2%), 53 were treated with total laryngectomy+partial hypopharynx resection (54.6%), 12 were treated with total laryngectomy and total hypopharynx resection, gastric-pharyngeal anastomosis (12.4%) and 4 were treated with total laryngectomy and total hypopharynx resection, enteric-pharyngeal anastomosis (4.1%).Sixty-one cases undergo postoperative radiotherapy in Oncology.Use Chi-square test to do enumeration data analysis, the survival rate is calculated with the life table method, survival analysis with Kaplan-Meier method, parallel Log-rank test. Cox regression multivariate analysis model is used to find the factors affecting prognosis.Result: The follow-up rate of this group was 90.7%. All patients' 1-year survival rate is 76.0%, 3-year survival rate is 56.0%, pathological lymph node metastasis rate is 71.1%, occult lymph node metastasis rate is 19.6%. Local recurrence rate is 21.6%. The main reasons of death in patients include:cervical lymph node metastasis in 7 patients (21.9%), local recurrence in 12 cases (37.5%), distant metastases in 10 patients (31.3%) and so on.Univariate analysis showed that tumor size (P<0.01) and tumor T stage (P<0.05) have impact on survival prognosis, no risk factors was found with Cox regression multivariate analysis.Conclusion: Hypopharyngeal carcinoma is difficult to be found early, prone to recurrence and metastasis after operation, carefully chosen surgical excision and neck dissection, adjuvant postoperative radiation therapy is the main treatment strategy. Posterior pharyngeal wall carcinoma tend to have higer recurrence and metastasis rate than the other two types of hypopharyngeal caocinom, and treatment would cause much larger injury, so more attention should be paid to this type of hypopharyngeal caocinom.
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