【摘要】：目的:探討喉癌術(shù)后復(fù)發(fā)的治療效果。 方法:回顧性分析大連醫(yī)科大學(xué)附屬第一醫(yī)院耳鼻咽喉科自1998—2009年收治的742例喉癌患者中45例術(shù)后復(fù)發(fā)病人的臨床資料。其中聲門型復(fù)發(fā)29例，聲門上型復(fù)發(fā)14例，跨聲門型復(fù)發(fā)2例;局部復(fù)發(fā)22例，頸部復(fù)發(fā)15例，遠(yuǎn)處轉(zhuǎn)移8例。全部病例均有隨訪，失訪兩例，以死亡計(jì)。并應(yīng)用Kaplan-Meier法進(jìn)行生存分析。 結(jié)果:喉癌患者術(shù)后的復(fù)發(fā)部位包括局部復(fù)發(fā)、頸部復(fù)發(fā)及遠(yuǎn)處轉(zhuǎn)移；喉鱗癌復(fù)發(fā)的時(shí)間為3-119個(gè)月，中位時(shí)間為18個(gè)月，術(shù)后一年復(fù)發(fā)29例，術(shù)后二年復(fù)發(fā)11例，術(shù)后三年以上復(fù)發(fā)5例，本組資料術(shù)后復(fù)發(fā)的時(shí)間特點(diǎn)與國(guó)內(nèi)資料相符；Kaplan-Meier法進(jìn)行生存分析結(jié)果表明，喉癌術(shù)后喉復(fù)發(fā)癌外科挽救治療后的總3、5年累及生存率分別為46.7%和17.8%，復(fù)發(fā)率為6.1%，較國(guó)內(nèi)數(shù)據(jù)低，此結(jié)果與我科部分患者多采用術(shù)后放療的治療方式有關(guān)。 結(jié)論:喉癌術(shù)后一年內(nèi)復(fù)發(fā)最為多見，應(yīng)重視術(shù)式的恰當(dāng)選擇和頸部淋巴結(jié)轉(zhuǎn)移的正確處理，臨床上應(yīng)密切隨訪，定期行影像學(xué)檢查，力爭(zhēng)早期發(fā)現(xiàn)復(fù)發(fā)灶，及時(shí)對(duì)喉復(fù)發(fā)癌行外科挽救手術(shù)，以期達(dá)到較好療效，本組3年生存率可到達(dá)46.7%；局部復(fù)發(fā)灶的手術(shù)方式以全喉切除為主，頸部復(fù)發(fā)以擴(kuò)大根治性頸清掃術(shù)為主；復(fù)發(fā)癌灶多有深部及喉外組織侵犯，手術(shù)難度大，組織缺損多，常需要修復(fù)，預(yù)后較差；對(duì)于晚期復(fù)發(fā)癌不能行手術(shù)者，可輔以放射、化學(xué)治療及其他治療；對(duì)侵及食管，影響進(jìn)食的患者可盡早做胃造瘺手術(shù)，，使這類晚期病人帶瘤生存能獲得一定的生存時(shí)間。
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R739.65

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