喉癌之治療－臺北榮總十年之病例分析

Treatments of Laryngeal Cancer - Analysis of Ten Years' Cases at VGH, Taipei

朱本元(Pen-Yuan Chu) ； 張學逸(Shyue-Yih Chang) ； 張斌(Ping Chang) ； 黃瑞麟(Jui-Lin Hwang) ； 蕭安穗(An-Suey Shiao) ； 彭武朗(Wu-Lung Peng) ； 蔡宏祺(Hung-Chi Tsai) ； 陳光超(Gwang-Chaw Chen)

《中華民國耳鼻喉科醫學會雜誌》 29卷5期 (1994/10) Pp. 376-383

https://doi.org/10.6286/1994.29.5.376

摘要

喉癌（laryngeal cancer）是男性常見的癌症之一，也是一種治癒率很高的癌症；依腫瘤之大小、位置的不同，而有各種不同的治療方法，以期在最高治癒率的原則下，儘可能保留喉部的重要機能。我們回顧性的將1981年7月至1991年6月這10年中，於本院癌病治療中心登錄有案之喉癌患者做為統計及分析的對象，除了針對患者的基本資料做分析之外，並對治療方式、手術方法、併及存活率等，做各種分析研究。在所有615例中，男性佔大多數；腫瘤生長部位以聲門為主；在腫瘤分期方面，第三期及第四期佔56%。在治療方面，所有的615例中，僅接受手術治療者有179例，接受放射線治療者有246例（其中27例局部復發再接受手術治療），接受手術及術前或術後放射線治療者共有118例。在手術治療方面，喉全切除有242例，喉部分切除術有58例，其它手術有24例；另外也有50例接受二氧化碳雷射手術，先將腫瘤做部分切除以解決呼吸道阻塞問題，再行其他治療。術後併發症並不常見，其中以氣管造口狹窄和咽皮瘻管為主。治療結果，聲門癌3年和5年存活率分別為82%及73%，聲門下癌為73%及67%，聲門上癌為64%及54%。聲門癌病例最多，故又分期比較手術及放射線治療之結果：手術治療的結果，3年和5年的存活率，第一期喉癌患者分別為100%及91%，第二期為95%及85%，第三期為88%及82%，第四期（多合併放射線治療）為72%及61%；放射線治療的結果，3年和5年的存活率，第一期喉癌患者分別為94%及93%，第二期為86%及71%，第三期為52%及42%，第四期為25%及0%。我們僅將過去10年來長期治療喉癌之經驗，提出分析報告，以做為喉癌治療以及進一步研究和發展之參考。

關鍵字

喉 ； 癌症

並列摘要

Between July 1981 and June 1991, 615 patients with laryngeal cancer were encounted in our department. These included 111 stage I patients (18%), 161 stage II patients (26%), 146 stage III patients (24%), and 197 stage IV patients (32%). Treatment modalities included surgery only in 179 patients (29%), surgery plus preoperative or postoperative radiation in 118 patients (19%), and radiation only in 246 patients (40%). There were 27 patients in the radiation group with post-irradiation recurrence and received salvage surgery. The surgical treatments included partial laryngectomy in 58 patients, total laryngectomy in 242 patients and other treatments in 24 patients. Fifty patients in our series received CO2 laser tumor debulking to resolve airway obstruction because of advanced cancer, and then further treatments were performed. As compared with other reports, our postoperative complications occurred less. It included stoma stenosis 9.9%, pharyngocutaneous fistula 7.8%, and wound infection 6.2%.
Overall 3-year and 5-year survival rates were 82% and 73% for glottic cancer; 64% and 54% for supraglottic cancer; 73% and 67% for subglottic cancer. For glottic cancer in particular, 3-year survival rates after treatment by radiation alone were 94%, 86%, 52% and 25% for stage I, II, III and IV; 5-year survival rates were 91%, 71%, 42% and 0% respectively. Three-year survival rates after treatments by surgery alone or surgery plus postoperative radiation were 100%, 95%, 88% and 72% for stage I, II, III, and IV; 5-year survival rates were 91%, 85%, 82%, and 61% respectively.
We retrospectively analysed the 10-year experience of treatments of laryngeal cancer and proper treatments for the different stage of laryngeal cancer were discussed.

並列關鍵字

larynx ； cancer