慈濟醫院喉癌之治療經驗

Treatment of Laryngeal Cancer at Buddhist Tzu Chi General Hospital

吳弘斌(Hung-Pin Wu) ； 徐莉萍(Lee-Ping Hsu) ； 陳培榕(Peir-Rong Chen)

《慈濟醫學雜誌》 13卷4期 (2001/12) Pp. 217-222

https://doi.org/10.6440/TZUCMJ.200112.0217

摘要

目的：喉癌在花東地區是次於口腔癌、鼻咽癌、下咽癌之後，佔頭頸部癌症排行第四，與全台灣頭頸部癌症排行依次為口腔癌、鼻咽癌、下咽癌、口咽癌，有差異。喉癌的治療因涉及發聲功能及種種生活習慣上的改變，使得病人在接受治療時較有疑慮。本報告藉由病例回溯性分析，回顧本院的治療成果。病人與方法：自民國79年8月至民國88年8月間，於本科診斷、治療，並設籍於花東地區的喉癌病患，病理報告則限於鱗狀上皮細胞癌者，始列入統計，合計有51人；本院治療原則為早期癌（stage I/II），以放射線治療或部喉切除為主，少數採用合併化學及放射線治療；晚期癌（stage III/IV），以全喉切除為主，術後再追加放射線治療或合併化學治療，但若病人不願意接受全喉切除術，則參酌病人的意願給予合併化學及放射線治療。追蹤日期至民國90年3月止，就各變項進行分析。結果：男性43人，女性8人。年齡分佈自33.0歲至90.0歲，平均年齡65.6歲。聲門上癌有7例，聲門癌有42例，聲門下癌有2例。根據1997年AJCC癌症分期為第一、二期的早期癌有26例，第三、四期的晚期癌有25例，依Kaplan-Meier分析法估計各組五年存活率，早期癌可達92.3%，全部則達73.1%。有16例因病人本身因素放棄治療或是延遲一個月以上才治療者，佔所病人的31.4%，平均延誤治療心間長達3.6個月，結論：花東地區因地形特景，交通不便，且兼病患的社經地位偏低，連帶影響就醫意願，造成往往已發展至晚期癌才就診，甚至還有將近三分之一的病患延遲或不治療。而喉癌中的早期癌五年存活率相當高，且診斷上亦不困難。故對於花東大眾疾病的教育方面，應多所著墨，以期達到早期診斷、早期治療的目標。

關鍵字

喉癌 ； 鱗狀上皮細胞癌 ； 花東地區

並列摘要

Objective: The treatment of laryngeal cancer involves changes in patients’ phono-function and living habits. Therefore, patients seem apprehensive about treatment. This report retrospectively analyzes our case at Tzi Chi General Hospital. Patients and Methods: from August 1990 to August 1999, 51 patents living in the Hua-Tung area were diagnosed with a pathological report of squamous cells carcinoma of the larynx and treated in our hospital. Stage I/II cancer patients received either radiation or partial laryngectomy and stage III/IV patients received a total laryngectomy with or without adjuvant therapy. Those cases were followed until March 2001 and analyzed by variety categories, including sex, age, stage, survival rate and so on. Results: There were 43 men and 89 women with ages ranging from 33 to 90 years. Twenty-six patients had stage I/II and 25 had stage III/IV disease. The estimations of each group’s five-year survival rate were 92.3%and 52.3% respectively. The five-year survival rate of all the patients was 73.1%. Due to personal reasons, 31.4% (16 cases) of patients discontinued or delayed treatment for over one month. The average length of delay was 3.6 months. Conclusion: The lower social-economic statusof the patients and the difficulty in accessing medical care in the Hua-Tung are caused delay in treatment. However the treatment results of laryngeal cancer were excellent. We should educate the general public in the Hua-Tung area to achieve early diagnosis and treatment.

並列關鍵字

laryngeal cancer ； squamous cell carcinoma ； Hua-Tung area