手术切缘对晚期声门型喉癌患者生存预后的影响

摘要

目的 探讨手术切缘对晚期声门型喉癌患者生存预后的影响.方法 选择接受手术治疗的140例晚期声门型喉癌患者,根据切缘情况分为阴性切缘与阳性切缘,比较二者局部复发率、区域性转移率;根据切缘范围分为≤3mm、4～5 mm、≥5 mm,比较三者局部复发情况;根据有无局部复发比较3年、5年生存率.结果 140例喉癌患者中28例患者的切缘为阳性,112例切缘阴性.阳性切缘患者中局部复发或淋巴结转移16例(57.14％),阴性切缘患者中局部复发或淋巴结转移19例(16.96％),差异具有统计学意义(P＜0.05).手术切缘≤3 mm的局部复发率为57.14％ (8/14),手术切缘4～5 mm的局部复发率为21.87％ (7/32),手术切缘≥5 mm的局部复发率为l0.64％(10/94),手术切缘≤3 mm的局部复发率显著高于手术切缘4～5 mm与≥≥5 mm的患者,比较差异具有统计学意义(P＜0.05).无局部复发患者3年、5年生存率分别为50.00％、36.61％,显著高于局部复发患者的17.86％、7.14％,比较差异具有统计学意义(P＜0.05).结论 手术切缘与晚期声门型喉癌患者的局部复发率及淋巴结转移率密切相关,切缘阳性患者复发率、转移率较高,预后较差,3年、5年生存率较低.术中可将切缘组织送快速冰冻病理检查,根据检查结果再实施手术,以降低切缘阳性率,减少复发,提高预后生存.%Objective To investigate the influence of surgical margin on prognosis of patients with advanced glottic laryngeal carcinoma.Methods 140 patients with advanced glottic cancer treated with surgery,according to the margin were divided into negative margins and positive margins;local recurrence rate comparison and regional transfer rate were compared;according to cutting edge margin were divided into ≤ 3 mm,4 ～5 mm,≥5 mm,compared local recurrence;the presence or absence of local recurrence were observed to compare 3-year and 5-year survival rates.Results 140 cases of laryngeal cancer patients resection margin in 28 patients were positive,negative margins routine pathological patients accounted for 80.00％.28 cases of patients with positive margins,16 patients with local recurrence or lymph node metastasis,and 112 cases of patients with negative margins in 15 patients followed up for local recurrence accounted for 12.50％,5 cases of lymph node metastasis accounted for 4.46％,the difference was statistically significant(P ＜ 0.05).Surgical margin ≤ 3 mm local recurrence rate was 57.14％ (8/14),surgical margin 4 ～5 mm local recurrence rate was 21.87％ (7/32),surgical margins ≥5 mm local recurrence rate was 10.64％ (10/ 94),the local recurrence rate ≤3 mm surgical margins were significantly higher than with surgical margin 4 ～ 5 mm ≥5 mm patients,the difference was statistically significant (P ＜ 0.05).No patients with local recurrence 3-year and 5-year survival rates were 50.00％,36.61％,significantly higher than 17.86％ in patients with local recurrence,7.14％ of 3-year and 5-year survival rate,and the difference was statistically significant (P ＜ 0.05).Conclusion The rate of local recurrence and lymph node metastasis and surgical margin rate advanced glottic carcinoma is closely related to the rate of relapse in patients with positive margins,higher transfer rate,resulting in poor prognosis patients so that 3-year and 5-year survival rate lower.Surgery may be sent to peripheral tissues quickly frozen biopsy,according to test results before the surgery to reduce the positive margin rate,reduce recurrence and improve patient survival.