摘要目的 分析喉部分切除术后喉复发癌的外科治疗方法、预后及影响预后的因素.方法 回顾分析中国医学科学院肿瘤医院头颈外科77例喉部分切除患者术后喉复发癌再行外科挽救治疗的临床资料.其中51例行喉全切除术,26例行喉部分切除术,其中19例无放疗史者行手术加放疗的综合治疗.Kaplan-Meier法统计生存率,Cox多因素分析影响预后的因素.结果 喉部分切除术后喉复发癌外科挽救治疗后的总3、5年累积生存率分别为59.1%和52.7%,累积局部复发率均为30.7%.局部未控是导致治疗失败的首要原因,占死亡例数的48.4%.Cox多因素回归分析表明,首次治疗原发灶分期晚和复发病变的喉外组织侵犯是影响预后的独立危险因素(P值均<0.05);首次治疗原发灶分期晚是局部复发的独立危险因素(x2=6.655,P=0.01,比值比=3.508).结论 喉部分切除术后喉复发癌的外科挽救治疗可获得较好的疗效.手术方式以喉全切除术为主,部分患者经严格选择再行喉部分切除术是可行的,可以获得较好的喉功能保留.

abstractsObjective To study surgical managements,outcomes and the factors affecting prognosis of the primary recurrence following partial laryngectomy for laryngeal carcinoma. Methods The clinical data of 77 patients with salvage surgery for primary recurrence following partial laryngectomy for laryngeal carcinoma were analyzed retrospectively. Fifty-one patients underwent salvage total laryngectomy and other 26 patients with salvage partial laryngectomy. Of them, 19 patients without previous radiatherapy received a combined therapy of surgery and radiatherapy. Survival rates were analyzed using Kaplan-Meier method.Prognosis factors were analyzed by Log-rank test and Cox regression. Results After salvage surgery, the 3-and 5-year cumulative overall survival rates were 59. 1% and 52. 7% respectively, and both the 3- and 5-year local recurrence rates were 30. 7%. Most patients(48.4% ) died of the failure at the primary sites.Multivariate analysis revealed the advanced T stage at initial presentation and the extra-laryngeal invasion of recurrent tumor were adverse prognostic factors for survival rate and also the advanced T stage at initial presentation influenced local recurrence rate. Conclusions Salvage surgery for the primary recurrence following conservation treatment for laryngeal carcinoma can achieve promising results. Salvage total laryngectomy is the main therapeutic management in most recurrent patients. Salvage partial laryngectomy can achieve sound results in the patients selected carefully.