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目的探讨梨状窝鳞状细胞癌(简称梨状窝癌)手术前或手术后放疗与喉功能保全治疗的效果。方法回顾性分析1985年9月—2001年7月收治的梨状窝鳞状细胞癌134例。术前放射治疗+手术治疗(简称R+S)100例,手术+术后放疗(简称S+R)34例。随访中位时间38.1个月。结果根据KaplanMeier方法统计R+S组与S+R组3年生存率分别为54.8%、50.1%,5年生存率分别为51.1%、45.9%,差异均无统计学意义(P>0.05)。T1、T2、T3和T4期患者在R+S组与S+R组喉功能保留情况分别为4/5、3/3,66.7%(32/48)、6/6,32.4%(12/37)、0(0/16)和0(0/10)、0/9,其中T3期喉功能保留率R+S组较高,与S+R组的差异有统计学意义(P<0.05),其喉功能保留与丧失在局部复发、生存率等相关因素差异无统计学意义。R+S组和S+R组术后大体标本切缘阳性率为7.0%(7/100)和20.6%(7/34),两者差异有统计学意义(P<0.05)。Cox多因素变量分析切缘阳性、临床N分期对预后呈明显相关(P值均<0.05)。结论计划性术前放疗与术后放疗在下咽梨状窝癌的治疗上具有相同疗效。声门旁间隙受侵的T3病例选择R+S治疗可以提高喉功能的保留率,不增加预后的风险。R+S治疗方式切缘阳性率低,对喉功能的保留提供可靠客观依据。临床N分期对预后影响很大,是综合治疗的难点。
Objective To investigate the effect of radiotherapy and preserving laryngeal function before or after operation on piriform pit squamous cell carcinoma (referred to as pear-shaped pit carcinoma). Methods Retrospective analysis of 134 cases of squamous cell carcinoma of the pear-shaped nest admitted from September 1985 to July 2001. Preoperative radiotherapy + surgery (R + S) in 100 cases, surgery + postoperative radiotherapy (referred to as S + R) in 34 cases. The median follow-up time was 38.1 months. Results According to the KaplanMeier method, the 3-year survival rates of R + S group and S + R group were 54.8% and 50.1%, respectively. The 5-year survival rates were 51.1% and 45.9% respectively, with no significant difference (P> 0.05). In T1, T2, T3 and T4 patients, the laryngeal function in R + S group and S + R group was 4 / 5,3 / 3,66.7% (32/48), 6 / 6,32.4% (12 / 37), 0 (0/16) and 0 (0/10), 0/9, respectively. The retention rate of T3 laryngeal function in R + S group was higher than that in S + R group (P <0.05) ), The retention and loss of laryngeal function in local recurrence, survival rate and other related factors was not statistically different. The positive rate of the gross margin of the gross specimen in the R + S group and the S + R group was 7.0% (7/100) and 20.6% (7/34) respectively, with significant difference between the two groups (P <0.05). Cox multivariate analysis of positive margins, clinical stage N was significantly correlated with prognosis (P all <0.05). Conclusions The planned preoperative radiotherapy and postoperative radiotherapy have the same effect in the treatment of hypopharyngeally popliteal carcinoma. The T3 patients treated with periosteal glottavasia in the treatment of R + S may improve the retention of laryngeal function without increasing the risk of prognosis. R + S treatment of positive margins of the margin, the retention of laryngeal function to provide a reliable and objective basis. The clinical stage of N has a great impact on prognosis, is the difficulty of comprehensive treatment.