以開放性部分咽喉切除手術治療早期原發部位下咽癌之成效、功能及生活品質分析

Analysis of Oncologic Result, Functional Outcomes and Quality of Life Following Open Partial Laryngopharyngectomy for Early Primary Hypopharyngeal Carcinoma

陳力揚(Li-Yang Chen) ； 連景峯(Ching-Feng Lien) ； 黃澤人(Tzer-Zen Hwang)

《台灣耳鼻喉頭頸外科雜誌》 51卷3期 (2016/09) Pp. 142-150

https://doi.org/10.6286/2016.51.3.142

摘要

背景：早期下咽癌(T1-T2)治療方式有放射化學治療、經口雷射手術或開放性部分咽喉切除手術。近年來，病患主觀滿意度已變成治療選擇的重要考量，而文獻上卻鮮少有早期原發部位下咽癌手術治療主觀滿意度的報告。本篇目的即分析本院早期原發部位下咽癌接受部分咽喉切除手術後存活率、功能和生活品質的結果，以期有助此等疾病治療選擇的參考。方法：回溯性收集在本院於2007年9月至2013年10月間，13名接受開放性部分咽喉切除手術之早期原發下咽癌病患，排除腫瘤侵犯會厭、環狀軟骨後區、梨狀窩頂和下咽癌曾接受雷射或放射化學治療者。分析存活率、併發症、功能和評估生活品質滿意度。結果：T1及T2分別是2例和11例，Stage I、II、III、IV分別佔8%、38%、8%、46%。5年整體存活率和疾病相關存活率分別是89.5%和89.5%。術後併發症的發生率為30.7%，發生率高低依序為肺炎15.4%、咽食道狹窄7.7%、傷口感染7.7%，乳糜漏7.7%。術後鼻胃管和氣切管皆移除。頭頸問卷EORTC QLQ-H&N35關於吞嚥和語言表現皆優於EORTC參考數據；PSS-HN問卷呈現大部份病人可食用青菜類食物，而所說的言語他人均能瞭解。結論：T1-2下咽癌以開放性部份咽喉切除治療，其術後存活率、功能和生活品質可達令人滿意結果。

關鍵字

hypopharyngeal cancer ； open partial pharyngolaryngectomy ； survival rate ； quality of life（下咽癌 ； 開放性部分咽喉切除手術 ； 存活率 ； 生活品質）

並列摘要

BACKGROUND: The treatment options for early primary hypopharyngeal cancer (T1-T2) include radiotherapy/chemoradiotherapy, transoral laser microsurgery and open partial laryngopharyngectomy. In recent years, the patient's subjective satisfaction has become an important factor to influence the choices of treatment; however literature regarding this topic is scanty. The aim of this study was to evaluate the outcome of the patients receiving open partial laryngopharyngectomy in terms of survival rate, function and quality of life and to facilitate the decision making process for the treatment of such disease. METHODS: From September 2007 to October 2013, 13 patients who underwent open partial laryngopharyngectomy were retrospectively enrolled in this study, excluding those who had tumors invading epiglottis, post-cricoid or pyrifom sinus apex and had received transoral laser microsurgery or radiotherapy/chemoradiotherapy for the early primary hypophrayngeal cancer. Data regarding survival rate, complication, function and quality of life were collected for analysis. RESULTS: Of these 13 patients, 2 were with pT1 and 11 with pT2 (8% stage I, 38% stage II, 8% stage III and 38% stage IV). The 5-year overall survival and diseasespecific survival rate were 89.5% and 89.5%. The overall complication rate was 30.7%, which included pneumonia (15.4%), and followed by pharyngoesophageal stenosis (7.7%), wound infection (7.7%) and chylous leakage (7.7%). All the nasogastric tube and tracheotomy tube were removed finally. The results of the Head and Neck questionnaire (QLQ-H&N35) showed that swallowing and speech results for these patients were better than EORTC reference; The PSS-HN questionnaire showed most patients in the study could eat vegetables and offer talks with the level of ＂Understandable most of the time＂. CONCLUSIONS: The overall outcomes of the T1-2 hypopharyngeal cancer patients receiving open partial laryngopharyngectomy were satisfactory, in terms of survival rate, function and quality of life.

並列關鍵字

hypopharyngeal cancer ； open partial pharyngolaryngectomy ； survival rate ； quality of life