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目的:探讨老年下咽癌喉功能保留手术的适应证和治疗方法。方法:分析41例老年下咽癌患者临床资料,其中保留喉功能病例25例。肿瘤切除后,下咽部缺损根据其大小采用邻近组织瓣或(和)胸大肌肌皮瓣修复。用Kaplan-Meier法计算生存率。结果:25例喉功能保留中,60~69岁16例,70~79岁6例,80~88岁3例;肿瘤位于梨状窝外侧壁14例,位于梨状窝前壁3例,位于梨状窝内侧壁3例,位于下咽侧壁上部侵犯扁桃体或舌根3例,位于下咽后壁2例。该组术后平均住院日22.2d;并发症发生8例(32%),其中6例咽漏,2例肺部感染。25例均恢复了呼吸和发声功能,其中有20例拔出气管套管,拔管时间平均为术后3个月左右。2例随访1年后失访;14例死于肿瘤复发转移,其中2例死于局部复发,4例死于颈部复发,8例死于肺部转移。该组1、3年生存率分别为67.5%和43.9%。结论:老年下咽癌只要病例选择适当且修复方法可行,保留喉功能的手术是可行的。
Objective: To investigate the indications and treatment of laryngeal function retention in elderly patients with hypopharyngeal carcinoma. Methods: The clinical data of 41 cases of elderly patients with hypopharyngeal carcinoma were analyzed, of which 25 cases were preserved laryngeal function. After tumor resection, the hypopharyngeal defect is reconstructed with adjacent tissue flaps or (and) pectoralis major myocutaneous flaps according to its size. Survival was calculated using Kaplan-Meier method. Results: Twenty-five cases of laryngeal function were preserved, 16 cases were 60-69 years old, 6 cases were 70-79 years old and 3 cases were 80-88 years old. The tumors were located in the lateral wall of the pear-shaped fossa in 14 cases, There were 3 cases of piriform fossa in the lateral wall, 3 cases of tonsil or tongue base in the inferior pharyngeal side wall, and 2 cases in the posterior pharyngeal wall. The average postoperative hospital stay was 22.2 days. Complications occurred in 8 cases (32%), including 6 cases of throat leakage and 2 cases of pulmonary infection. Twenty-five patients recovered their respiratory and vocal functions. Twenty of them had tracheal cannulas removed, and the average time of extubation was about 3 months after operation. Two patients were followed up one year later and 14 patients died of tumor recurrence and metastasis. Two patients died of local recurrence, four died of neck recurrence and eight died of pulmonary metastasis. The 1-year and 3-year survival rates were 67.5% and 43.9% respectively. Conclusion: The treatment of hypopharyngeal carcinoma in elderly patients with laryngeal function is feasible only when the cases are selected properly and the repair method is feasible.