摘要
目的探讨喉全切除术后气管造口复发癌挽救性手术治疗的相关问题。方法回顾性分析白求恩国际和平医院耳鼻咽喉头颈外科1990年1月-2006年1月手术治疗的36例气管造口复发癌的临床资料，对术前综合评估、手术技术、手术方式、围手术期并发症的处理和治疗效果进行综合研究和分析。结果经过术前评估和预测，33例患者的肿瘤得以完整切除。本组患者术后1年、2年和3年总体生存率分别为68．8％（21／32）、43．8％（14／32）和12．5％（4／32）。2例患者分别在术后3周和2个月发生颈总动脉和无名动脉破裂短期内死亡。甲状腺全切患者术后出现不同程度的甲状腺功能低下症状23例次，其中8例出现明显的甲状旁腺功能低下症状；术后伤口感染发生咽瘘6例次（其中1例因感染造成颈动脉破裂）；胸部供皮区伤口裂开3例次；胸壁血肿4例次；术后2个月发现胸壁供皮区肿瘤种植转移1例次；术后3～6个月出现不同程度咽狭窄6例次（其中4例为感染后咽瘘者）。上述各类并发症均经合理治疗而治愈。结论喉全切除术后气管造口复发癌病情凶险，情况复杂，预后差，手术治疗可以挽救和延长部分患者的生命。实施气管造口复发癌的挽救性手术需要合理选择手术适应证，充分注意术前评估和围手术期有关问题的处理。
Objective To explore the related issues concerning salvage surgery for stomal recurrence （SR） after total laryngectomy. Methods A retrospective study was conducted to analyse the clinical data from 36 patients suffering from SR after total laryngectomy, who were treated by salvage surgery from January 1990 to January 2006. Some related issues concerning salvage surgery for SR were studied and analysed, which include preoperative evaluations, surgical approaches and techniques, management of perioperative complications and outcomes of treatment. Results After careful preoperative evaluations and predictions, a complete resection of tumor was achieved in 33 out of 36 SR patients. Two patients sacrificed because of ruptures of major vessels including the common carotid eatery and the innominate artery 3 weeks and 2 months after the operation. The overall 1 -year, 2-year and 3-year survival of this group of patients were 68.8%, 42. 8% and 12. 5%, respectively. Besides, postoperative complications comprise 23 cases of hypothyroidisms, 6 eases of wound infection and saliva leakage, 8 cases of donor site complications （ including dehiscence of wound in 3 cases, chest wall hematomas in 4 cases, and tumor seeding in 1 case） , and hypopharyngeal stenosis in 4 cases, all of which were properly and promptly managed with uneventful outcomes. Conclusions SR after total laryngectomy is a dangerous and complicated status with poor prognosis. For the purpose of saving or elongating the patients＇ s lives, the salvage surgery needs to be done on the condition that indicated candidates are properly selected, preoperative evaluations carefully conducted, and perioperative abnormal conditions unerroneously delt with.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2009年第9期731-735,共5页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
喉肿瘤
气管造口术
肿瘤复发
局部
挽救疗法
预后
Laryngeal neoplasms
Tracheostomy
Neoplasm recurrence, local
Salvage therapy
Prognosis
