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目的:探讨>65岁高龄下咽癌患者喉功能保留手术的疗效。方法:>65岁高龄下咽癌患者58例,分为喉功能保留组31例和喉功能未保留组27例。术前均行完善的术前准备,术中肿瘤切除标本送冷冻证实切缘阴性后应用局部缝合、带状肌皮瓣、胸大肌皮瓣、裂层皮片、胃代食管等对缺损进行修复,术后均行根治性放疗。用Kaplan-Meier法计算生存率,用卡方检验比较两组并发症。结果:所有患者3、5年生存率分别为48.3%(28/58)和27.6%(16/58)。喉功能保留组3、5年生存率分别为51.6%(16/31)和29.0%(9/31);喉功能未保留组分别为44.4%(12/27)和25.9%(7/27),3、5年生存率差异均无统计学意义(P>0.05)。两组并发症的发生率分别为45.2%(14/31)和40.7%(11/27),差异无统计学意义(P>0.05)。结论:高龄下咽癌患者根据其全身状况及肿瘤的侵犯范围选择喉功能保全是可行的,关键是充分做好围手术期处理,正确掌握适应证,提高术中修复技巧。
Objective: To investigate the efficacy of preserving laryngeal function in patients with hypopharyngeal carcinoma at the age of 65 years. Methods: Fifty-eight patients with hypopharyngeal carcinoma under the age of 65 were divided into three groups: the laryngeal function reserve group (n = 31) and the laryngeal function reserve group (n = 27). Preoperative complete preoperative preparation, intraoperative resection of the tumor samples sent to the frozen negative margins confirmed by the application of local suture, strip myocutaneous flap, pectoralis major flap, split layer of skin, gastric esophageal on the defect Repair, postoperative radical radiotherapy. Survival rates were calculated using the Kaplan-Meier method and the two groups of comparisons were compared using the chi-square test. Results: The 3-year and 5-year survival rates of all patients were 48.3% (28/58) and 27.6% (16/58), respectively. The three-year and five-year survival rates of the laryngeal functional reserve group were 51.6% (16/31) and 29.0% (9/31), respectively. The laryngeal function unreserved group was 44.4% (12/27) and 25.9% (7/27) There was no significant difference in the 3-year and 5-year survival rates (P> 0.05). The incidence of complications in both groups were 45.2% (14/31) and 40.7% (11/27) respectively, with no significant difference (P> 0.05). CONCLUSION: It is feasible to select laryngeal function preservation according to the condition of the whole body and the scope of tumor invasion in elderly patients with hypopharyngeal carcinoma. The key is to fully perform the perioperative management, correctly understand the indications and improve the intraoperative rehabilitative skills.