王晓敏, 张俊杰, 韩国英, 陈德尚, 张明洁, 韩跃峰, 孙谦, 马士崟, 李慧. 不同T分期下咽癌手术入路及修复方法的选择[J]. 蚌埠医学院学报, 2023, 48(12): 1652-1656. DOI: 10.13898/j.cnki.issn.1000-2200.2023.12.007
    引用本文: 王晓敏, 张俊杰, 韩国英, 陈德尚, 张明洁, 韩跃峰, 孙谦, 马士崟, 李慧. 不同T分期下咽癌手术入路及修复方法的选择[J]. 蚌埠医学院学报, 2023, 48(12): 1652-1656. DOI: 10.13898/j.cnki.issn.1000-2200.2023.12.007
    WANG Xiao-min, ZHANG Jun-jie, HAN Guo-ying, CHEN De-shang, ZHANG Ming-jie, HAN Yue-feng, SUN Qian, MA Shi-yin, LI Hui. Selection of surgical approaches and repair methods for hypopharyngeal carcinoma with different T stages[J]. Journal of Bengbu Medical College, 2023, 48(12): 1652-1656. DOI: 10.13898/j.cnki.issn.1000-2200.2023.12.007
    Citation: WANG Xiao-min, ZHANG Jun-jie, HAN Guo-ying, CHEN De-shang, ZHANG Ming-jie, HAN Yue-feng, SUN Qian, MA Shi-yin, LI Hui. Selection of surgical approaches and repair methods for hypopharyngeal carcinoma with different T stages[J]. Journal of Bengbu Medical College, 2023, 48(12): 1652-1656. DOI: 10.13898/j.cnki.issn.1000-2200.2023.12.007

    不同T分期下咽癌手术入路及修复方法的选择

    Selection of surgical approaches and repair methods for hypopharyngeal carcinoma with different T stages

    • 摘要:
      目的探讨不同T分期下咽癌的手术入路及咽喉缺损修复方法的选择与体会。
      方法回顾性分析手术治疗的65例下咽癌病人的临床资料,其中男64例,女1例,年龄42~77岁。临床分期Ⅰ期1例,Ⅱ期8例,Ⅲ期31例,Ⅳ期25例;均无远处转移。采用全喉全下咽部分食管切除1例,全喉部分下咽切除24例,部分喉部分下咽切除36例,部分下咽切除4例。所有病人均行颈部淋巴清扫术。手术入路:食管入路1例,咽侧入路2例,会厌前间隙入路6例,环后入路9例,声门旁间隙入路11例,咽侧联合甲舌膜入路13例,甲状软骨裂开联合会厌前间隙入路17例,联合入路6例。使用残喉气管组织瓣、颏下岛状皮瓣、胸大肌瓣等行咽及部分食管功能重建,采用会厌、带状肌筋膜瓣、甲状软骨膜瓣等行喉腔的修复。Ⅰ期和Ⅱ期未行放疗,Ⅲ期和Ⅳ期均行术后辅助放疗(剂量50~60 Gy),部分病例术前行铂类新辅助化疗和术后同步放化疗。
      结果病人3年总生存率63.9%,无疾病生存率51.8%;5年总生存率42.6%,无疾病生存率41.7%。喉功能保留率61.5%,气管套管拔除率38.5%。术后病理证实颈部淋巴结阳性率66.2%,咽瘘发生率9.2%。平均胃管拔除时间21.8 d,2例吻合口狭窄。
      结论根据不同T分期及病人全身情况选择合适的手术入路和修复方法可充分暴露肿瘤,精准化保存正常黏膜,缩小缺损范围,减少修复创伤,在保证病人生存率的情况下提高下咽癌喉功能保留率。

       

      Abstract:
      ObjectiveTo investigate the selection of surgical approaches and throat defect repair methods for hypopharyngeal carcinoma with different T stages.
      MethodsThe clinical data of 65 patients with hypopharyngeal cancer who underwent operational repairment were retrospectively analyzed.Of all patients who aged 42-77 years, 64 were males and 1 was female, 1 case had stage Ⅰ, 8 cases had stage Ⅱ, 31 cases had Ⅲ, 25 cases had stage Ⅳ of hypopharyngeal carcinoma and no distant metastasis was detected.On surgical methods, 1 case received total laryngectomy with partial esophagectomy, 24 cases received total laryngectomy with partial hypopharynx, 36 and 4 cases were subjected to partial hypopharynx and partial hypopharynx, respectively.All patients underwent neck dissection.On surgical approaches: esophageal approach in 1 case, pharyngeal approach in 2 cases, epiglottic anterior space approach in 6 cases, retrocricoid approach in 9 cases, supraglottic space approach in 11 cases, pharyngeal combined thyroglossal membrane approach in 13 cases, thyrochondral dehiscence combined with epiglottic anterior space approach in 17 cases and combined approach in 6 cases.The residual laryngotracheal tissue flap, submental island flap and pectoralis major muscle flap were used to reconstruct the function of pharynx and part of esophagus, and epiglottis, band myofascial flap and thyroid perichondrium flap were used to repair the laryngeal cavity.No radiotherapy was given in stage Ⅰ and Ⅱ, and postoperative adjuvant radiotherapy was given in stage Ⅲ and Ⅳ (dose 50-60 Gy).Some cases were treated with platinum neoadjuvant chemotherapy before operation and concurrent radiotherapy and chemotherapy after operation.
      ResultsThe 3-year overall survival rate was 63.9%, the disease-free survival rate was 51.8%, the 5-year overall survival rate was 42.6%, and the disease-free survival rate was 41.7%.Laryngeal function retention rate was 61.5%, and tracheal casing expulsion rate was 38.5%.Postoperative pathology confirmed that the positive rate of cervical lymph nodes was 66.2%, and the incidence of pharyngeal fistula was 9.2%.The average time of gastric tube removal was 21.8 days, and 2 patients had anastomotic stenosis.
      ConclusionsAppropriate surgical approach and throat repair methods according to different stages of hypopharyngeal carcinoma can be beneficial in operational exposure, mucosa preservation, defects narrowing, surgical trauma reduction, and can improve the laryngeal function retention rate of hypopharyngeal carcinoma while ensuring the survival rate of patients.

       

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