摘要：
目的 探讨高龄(>70岁)梨状窝内侧壁癌患者行术前放疗和术后放疗的临床疗效及喉功能保全手术的可行性.方法 回顾性分析安徽医科大学第一附属医院耳鼻咽喉头颈外科2001年1月至2010年12月收治的48例>70岁梨状窝内侧壁癌手术治疗患者的临床资料,其中术前放疗+手术组21例,放疗平均剂量为45 Gy;14例保留喉功能,7例未保留喉功能.手术+术后放疗组27例,放疗平均剂量为65 Gy;10例保留喉功能,17例未保留喉功能.比较两组患者的保喉率、拔管率、并发症的发生率以及生存率等指标.结果 术前放疗+手术组和手术+术后放疗组患者的保喉率分别为66.7％(14/21)和37.0％(10/27),差异有统计学意义(P=0.042).术前放疗+手术组保留喉功能患者的拔管率为64.3％(9/14),手术+术后放疗组保留喉功能患者的拔管率为50.0％(5/10),差异无统计学意义(P=0.680).术前放疗+手术组患者术后并发症的发生率为42.9％(9/21),手术+术后放疗组患者术后并发症的发生率为37.0％(10/27),差异无统计学意义(P=0.680).喉功能保留组和未保留组患者并发症的发生率分别为41.7％(10/24)和37.5％(9/24),差异无统计学意义(P=0.770).全组48例患者的3年和5年生存率分别为54.2％和35.4％.术前放疗+手术组和手术+术后放疗组患者的5年生存率分别为38.1％和33.3％,差异无统计学意义(P>0.05).术前放疗+手术组患者中保留喉功能者与未保留喉功能者的5年生存率分别为35.7％和42.9％,差异无统计学意义(P=0.860).手术+术后放疗组患者中保留喉功能和未保留喉功能者的5年生存率分别为40.0％和29.4％,差异无统计学意义(P=0.240).结论 部分>70岁高龄梨状窝内侧壁癌患者根据全身情况及肿瘤的侵犯范围,在安全切除肿瘤的前提下选用保留喉功能手术是可行的;对于高龄梨状窝内侧壁癌患者,术前放疗与术后放疗具有相同的疗效,且术前放疗可提高患者保留喉功能的概率.%Objective To investigate the clinical efficacy of preoperative-, postoperative-radiotherapy and surgery for preserving laryngeal function in patient over 70 years of age with medial wall pyriform sinus cancer. Methods Clinical data of 48 patients over 70 years of age with medial wall pyriform sinus cancer who received surgical treatment from January 2001 to December 2010 were retrospectively analyzed. Among them, 21 cases were given preoperative radiotherapy and surgery (R+S). The radiation therapy dose was 45 Gy. And 14 cases′ larynx is preserved. In addition, 27 cases were given postoperative radiotherapy and surgery ( S+R ) . The radiation therapy dose was 65 Gy. And 10 cases had preserved laryngeal function. Survival rates were analyzed by the Kaplan-Meier method. Chi-square test was used to compare complications between two groups. Results The larynx preservation rate in R+S group [ 66. 7％(14/21)] was significantly higher than that in S+R group [37.0％ (10/27), P0.05). The complication rates of patients with and without larynx preservation were 41.7％ (10/24) and 37.5％ (9/24), respectively, showing no difference between two groups (P>0.05). The overall 3-years and 5-years survival rates for all patients were 54.2％ (26/48) and 35.4％ (17/48), respectively. There was no significant difference in survival rates between R+S [38.1％(8/21)] group and S+R group [33.3％(9/27), P>0.05)]. In the R+S group, the survival rates in patients with and without larynx preservation were 40.0％(4/10) and 29.4％ (5/17), respectively, showing no significant difference between two groups (P>0.05). Conclusions It is secure and effective to choose the operation with laryngeal preservation for patient over 70 years of age with medial wall pyriform sinus cancer based on their physical conditions and the tumor extension. The preoperative-and postoperative-radiotherapy have the similar effect. Preoperative radiotherapy and surgery increases the laryngeal preservation rate.
