發(fā)布時間：2018-07-09 19:46

  本文選題：下咽 + 鱗狀細胞癌�。� 參考：《復旦大學》2014年博士論文

【摘要】：[目的]總結分析下咽鱗癌的基本臨床特點,治療方式及預后因素,為建立下咽癌規(guī)范化手術治療提供更多循證醫(yī)學資料。[對象與方法]研究對象為2003年1月至2013年6月期間復旦大學附屬眼耳鼻喉科醫(yī)院耳鼻喉科收治并行外科手術治療的下咽鱗癌病例。研究內容分為兩部分。第一部分,收集所有患者發(fā)病年齡、性別、首發(fā)癥狀、病程、術后住院時間等臨床基本信息,并對腫瘤部位、臨床分期、病理組織學分級進行統(tǒng)計,隨訪患者術后生存情況,利用Kaplan-Meier法進行生存分析。第二部分,對所有下咽癌手術的原發(fā)腫瘤切除方式、頸淋巴結清掃術式、咽部缺損重建形式及術前術后綜合治療方式進行分類,比較不同治療方式的療效、并發(fā)癥及患者預后。[結果]第一部分,本次研究共計納入患者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),腫瘤復發(fā)的危險因素為原發(fā)腫瘤T分期和脈管癌栓(p0.001)第二部分,本組研究對象中375例(97.2%)為計劃性手術,11例(2.8%)為挽救性手術。82例(21.2%)患者行喉功能保留手術,341例(88.3%)患者接受頸淋巴結清掃術,共399側頸清(單側頸清283例,雙側頸清58例)。103例(26.7%)行胸大肌皮瓣、前臂游離皮瓣、胃咽吻合術等缺損修復重建術。喉功能保留手術在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期病例接受修復重建手術比例(30.9%)高于T1-2期(16.7%)(p=0.004)。術前接受綜合治療者44例(11.4%),分別為6例放療,25例化療,13例放療聯(lián)合化療。術后接受綜合治療者234例(60.6%),包括術后放療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)腫瘤切除術式、頸淋巴結清掃術式及術后綜合治療方式對患者生存率無明顯影響。[結論]下咽腫瘤預后差,目前治療方式是以手術為主的綜合治療,應行全面術前檢查并對腫瘤進行嚴格分期,選擇合適的原發(fā)腫瘤切除、頸淋巴結清掃和缺損修復重建方式。
[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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