学术论文

      等离子射频辅助经口手术治疗下咽癌

      Transoral radiofrequency coblation surgery for the treatment of hypopharyngeal carcinoma

      摘要:
      目的 初步探讨等离子射频(radiofrequency coblation,RFC)辅助经口手术(transoral surgery,TOS)治疗下咽癌的可行性及有效性.方法 回顾性分析2010-2016年接受RFC辅助TOS治疗的22例下咽癌患者,其中梨状窝癌15例,环后癌4例,下咽后壁癌3例;根据AJCC2002年指南,分期为T1 N0M0患者3例,T2N0M0患者9例,T1N1M0患者1例,T1 N2M0患者1例,T2N1M0患者4例,T2N2M0患者4例.所有术前评估存在淋巴结转移的患者均接受了同期的颈淋巴清扫术,2例患者接受了同期的预防性气管切开术;17例患者接受了术后的放射治疗,剂量范围为50 ~ 66 Gy;术后随访时间范围为6 ~72个月,中位值为35个月.2例患者失访.结果 纳入研究的22例患者中2例完成肿瘤切除手术后因肿瘤范围超过术前评估,不能确保安全切缘而中转改为开放手术,其余20例患者均顺利完成TOS治疗.术后除1例患者因疼痛恢复经口进食较慢外,其余患者均在1周内恢复经口进食;完成随访的18例患者中3例(16.7%)局部复发,其中1例(5.6%)因局部复发、多原发食管癌及远处转移于术后4年死亡,根据Kaplan-Meier法计算得到的5年局部控制率及总体生存率分别为57.8%及67.5%.所有患者在随访中均未发现发音、吞咽及呼吸功能等方面的障碍.结论 RFC辅助TOS治疗下咽癌是可行的,其切割效率高及控制术中出血更佳的特点有助于降低手术的难度,随访的数据证实此类手术疗效确切且患者功能保留率高.
      Abstract:
      Objective To explore the feasibility and effectiveness of transoral surgery (TOS) for the treatment of hypopharyngeal carcinoma by means of the radiofrequency coblation (RFC).Methods Twenty-two patients with hypopharyngeal carcinoma who were treated with TOS using RFC during the years of 2010-2016 were enrolled.Among these patients,15 suffered from pyriform sinus carcinoma,4 suffered from postcricoid carcinoma,and 3 suffered from posterior hypopharyngeal wall carcinoma.According to the AJCC 2002 guideline,the tumor stages were T1N0M0 for 3 patients,T2N0M0 for 9 patients,T1N1M0 for 1 patient,T1N2M0 for 1 patient,T2N1M0 for 4 patients,and T2N2M0 for 4 patients respectively.All patients with N + underwent concurrent neck dissection;2 patients underwent concurrent prophylactic tracheotomy;17 underwent post-operative radiotherapy for 50-66 Gy.The follow-up time was 6-72 months with a median 35 months.Two patients were lost to follow-up.Results All patients except 2 underwent the TOS successfully,while the two patients were treated with open approach surgery due to unsure safe margin.Most patients returned to oral feeding within one week.Among the 18 patients with complete follow up data,3 had the local recurrence of the tumor (16.7%) and one died due to local recurrence,multiple primary esophageal carcinoma,and distant metastasis 4 years after surgery (5.6%).According to the Kaplan-Meier method,the 5-years local control rate and survival rate were 57.8% and 67.5% respectively.All patients had no disorders in speech,swallowing and respiration during the follow up.Conclusions The RFC can be applied in TOS for the treatments of hypopharyngeal carcinoma with high cutting efficiency and better control of intraoperative hemorrhage,which is useful in lowering the operation difficulty.The oncologic results are comparable to the open surgery with satisfactory postoperative organ function preservation.
      作者: 肖水芳 [1] 李五一 [2] 张俊波 [1] 王剑 [2] 贾俊晓 [1] 杨大海 [2] 赵欣 [1] 霍红 [2] 沈泓 [1]
      Author: Xiao Shuifang [1] Li Wuyi [2] Zhang Junbo [1] Wang Jian [2] Jia Junxiao [1] Yang Dahai [2] Zhao Xin [1] Huo Hong [2] Shen Hong [1]
      作者单位: 100034,北京大学第一医院耳鼻咽喉头颈外科 100730,中国医学科学院北京协和医学院北京协和医院耳鼻咽喉科
      年,卷(期): 2017, 52(5)
      在线出版日期: 2017年6月20日