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目的评价不同治疗方式治疗梨状窝癌T3、T4病变的治疗效果。方法回顾性分析了1974年1月—1999年12月中国医学科学院肿瘤医院头颈外科初治的287例T3、T4梨状窝癌患者。根据治疗方式,分为4组:单纯放疗组(Ra组)134例,平均放疗剂量68.8 Gy;术前放疗加手术组(R+S组)125例,平均术前放疗剂量45.5 Gy,其中32例行喉功能保留手术;单纯手术组(Sa组)13例,全部为非喉功能保留手术;手术加术后放疗组(S+R组)15例,全部为非喉功能保留手术,平均术后放疗剂量56.3 Gy。结果Kap lan-M e ier方法计算Ra组、R+S组、Sa组和S+R组的5年生存率分别为23.13%、46.51%、18.33%和44.44%。综合治疗(R+S组和S+R组)与单纯治疗(Ra组和Sa组)的5年生存率分别为46.22%和22.60%。,两组间差异有统计学意义(P=0.000)。Cox模型对生存时间的多因素分析显示,对生存时间有影响的是治疗模式(P=0.000)和放疗效果(P=0.0070)Ra组、R+S组、Sa组和S+R组的喉功能保存率分别为14.08%、13.61%、0和0。Ra组、R+S组、Sa组和S+R组的并发症的发生率分别为14.93%、37.60%、53.84%、33.33%。结论术前放疗有助于T3、T4梨状窝癌患者喉功能的保留。
Objective To evaluate the therapeutic effects of different treatment methods on the treatment of T3 and T4 lesions of pear-shaped nest. Methods A retrospective analysis of January 1974 - December 1999 Cancer Hospital of Chinese Academy of Medical Sciences, head and neck surgery in the initial treatment of 287 cases of T3, T4 patients with pear-shaped nest cancer. According to the way of treatment, the patients were divided into 4 groups: 134 patients in radiotherapy alone group (Ra group), with an average radiotherapy dose of 68.8 Gy; 125 patients in radiotherapy plus operation group (R + S group), the average preoperative radiotherapy dose was 45.5 Gy, Routine laryngeal function preservation surgery was performed in all patients. Thirteen patients (Sa group) were treated with non-laryngeal function only. Fifteen patients in operation plus postoperative radiotherapy (S + R group) Post-radiation dose 56.3 Gy. Results Kaplan-Meier methods calculated the 5-year survival rates of Ra, R + S, Sa and S + R groups were 23.13%, 46.51%, 18.33% and 44.44%, respectively. The 5-year survival rates of combination therapy (R + S group and S + R group) and simple therapy (Ra group and Sa group) were 46.22% and 22.60% respectively. , The difference between the two groups was statistically significant (P = 0.000). Multivariate analysis of survival time in the Cox model showed that treatment-dependent (P = 0.000) and radiotherapy effects (P = 0.0070) had significant effects on survival in Ra, R + S, Sa and S + R groups Functional preservation rates were 14.08%, 13.61%, 0 and 0 respectively. The incidences of complications in Ra, R + S, Sa and S + R groups were 14.93%, 37.60%, 53.84% and 33.33%, respectively. Conclusions Preoperative radiotherapy is helpful for preserving laryngeal function in patients with T3 and T4.