本文選題：下咽 + 鱗狀細(xì)胞癌　； 參考：《復(fù)旦大學(xué)》2014年博士論文

【摘要】：[目的]總結(jié)分析下咽鱗癌的基本臨床特點(diǎn),治療方式及預(yù)后因素,為建立下咽癌規(guī)范化手術(shù)治療提供更多循證醫(yī)學(xué)資料。[對(duì)象與方法]研究對(duì)象為2003年1月至2013年6月期間復(fù)旦大學(xué)附屬眼耳鼻喉科醫(yī)院耳鼻喉科收治并行外科手術(shù)治療的下咽鱗癌病例。研究內(nèi)容分為兩部分。第一部分,收集所有患者發(fā)病年齡、性別、首發(fā)癥狀、病程、術(shù)后住院時(shí)間等臨床基本信息,并對(duì)腫瘤部位、臨床分期、病理組織學(xué)分級(jí)進(jìn)行統(tǒng)計(jì),隨訪患者術(shù)后生存情況,利用Kaplan-Meier法進(jìn)行生存分析。第二部分,對(duì)所有下咽癌手術(shù)的原發(fā)腫瘤切除方式、頸淋巴結(jié)清掃術(shù)式、咽部缺損重建形式及術(shù)前術(shù)后綜合治療方式進(jìn)行分類,比較不同治療方式的療效、并發(fā)癥及患者預(yù)后。[結(jié)果]第一部分,本次研究共計(jì)納入患者386例,其中男性370例(95.9%),女性16例(4.1%),患者平均年齡58.4±9.4歲。腫瘤部位：梨狀窩癌296例(76.7%),咽后壁癌67例(17.3%),環(huán)后癌23例(6.0%)。腫瘤TNM分期：T1期31例(8.0%),T2期83例(21.5%),T3期175例(45.3%),T4期97例(25.1%)；NO期99例(25.6%),N1期74例(19.2%),N2期181例(46.9%),N3期32例(8.3%)；M0期383例(99.2%),M1期3例(0.8%)。腫瘤臨床分期：Ⅰ期10例(2.6%),Ⅱ期29例(7.5%),Ⅲ期108例(28.0%),Ⅳ期239例(61.9%)。組織學(xué)分化程度：高-中分化355例(92.0%),低分化31例(8.0%)：發(fā)生第二原發(fā)腫瘤28例(7.3%)。Kaplan-Meier法計(jì)算3年總生存率(OS)、疾病特異生存率(DSS)和無病生存率(DFS)分別為51.8%、53.6%和49.6%,5年OS、DSS和DFS分別為45.8%、48.1%和46.0%。COX回歸模型顯示患者生存率的獨(dú)立影響因素為T分期(p0.001)、N分期(p=0.003)、及第二原發(fā)癌(p=0.017),腫瘤復(fù)發(fā)的危險(xiǎn)因素為原發(fā)腫瘤T分期和脈管癌栓(p0.001)第二部分,本組研究對(duì)象中375例(97.2%)為計(jì)劃性手術(shù),11例(2.8%)為挽救性手術(shù)。82例(21.2%)患者行喉功能保留手術(shù),341例(88.3%)患者接受頸淋巴結(jié)清掃術(shù),共399側(cè)頸清(單側(cè)頸清283例,雙側(cè)頸清58例)。103例(26.7%)行胸大肌皮瓣、前臂游離皮瓣、胃咽吻合術(shù)等缺損修復(fù)重建術(shù)。喉功能保留手術(shù)在T1-2期患者中的比例(22.0%)明顯高于T3-4期(12.1%)(p0.001),而T3-4期病例接受修復(fù)重建手術(shù)比例(30.9%)高于T1-2期(16.7%)(p=0.004)。術(shù)前接受綜合治療者44例(11.4%),分別為6例放療,25例化療,13例放療聯(lián)合化療。術(shù)后接受綜合治療者234例(60.6%),包括術(shù)后放療90例,化療8例,放療聯(lián)合化療131例,靶向聯(lián)合放療1例,靶向聯(lián)合放化療4例。104例(26.9%)患者出現(xiàn)術(shù)后并發(fā)癥,接受不同重建方式的患者生存率有顯著差異(p0.001),行前臂游離皮瓣、胸大肌肌皮瓣、胃上提胃咽吻合術(shù)的患者5年OS分別為34.2%、20.9%和13.7%。而原發(fā)腫瘤切除術(shù)式、頸淋巴結(jié)清掃術(shù)式及術(shù)后綜合治療方式對(duì)患者生存率無明顯影響。[結(jié)論]下咽腫瘤預(yù)后差,目前治療方式是以手術(shù)為主的綜合治療,應(yīng)行全面術(shù)前檢查并對(duì)腫瘤進(jìn)行嚴(yán)格分期,選擇合適的原發(fā)腫瘤切除、頸淋巴結(jié)清掃和缺損修復(fù)重建方式。
[Abstract]:[objective] to summarize and analyze the basic clinical features, treatment methods and prognostic factors of hypopharyngeal squamous cell carcinoma (HSCC), and to provide more evidence-based medical data for the establishment of standardized surgical treatment for hypopharyngeal carcinoma. [participants and methods] patients with hypopharyngeal squamous cell carcinoma treated by Otolaryngology Hospital affiliated to Fudan University from January 2003 to June 2013 were studied. The research is divided into two parts. In the first part, we collected the basic clinical information of all the patients, such as age, sex, initial symptom, duration of disease, duration of hospitalization after operation, and made statistics on tumor location, clinical stage, histopathological grading, and survival status of the patients after follow-up. Kaplan-Meier method was used for survival analysis. In the second part, the primary tumor resection, neck lymph node dissection, reconstruction of pharynx defect and comprehensive treatment before and after operation were classified to compare the curative effect, complications and prognosis of patients with hypopharyngeal carcinoma. [results] in the first part, 386 patients were included in this study, of whom 370 were male (95.9%) and 16 were female (4.1%). The average age of the patients was 58.4 鹵9.4 years old. There were 296 cases of Pyriform fossa carcinoma (76.7%), 67 cases of posterior pharyngeal wall carcinoma (17.3%) and 23 cases of posterior ring carcinoma (6.0%). There were 31 cases (8.0%) with TNM stage T1, 83 cases (21.5%) with T _ 2 stage, 175 cases (45.3%) with T _ 3 stage, 97 cases (25.1%) with no stage T _ 4, 99 cases (25.6%) with no stage, 74 cases (19.2%) with N _ 2 stage, 181 cases (46.9%) with N _ 2 stage, 383 cases (8.3%) with N _ 3 stage M _ 0 stage and 3 cases with M _ 1 stage (0.8%). There were 10 cases (2.6%) in stage 鈪，

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