Objective: To report the experience in comprehensive surgical treatment of pyriform sinus carcinoma via the paraglottic space approach. Methods: Three hundred and thirty-five cases with pyriform sinus carcinoma (according to UICC 2012 criteria, stage Ⅰ, 12 cases; Ⅱ, 36; Ⅲ, 79; Ⅳ, 208; T1, 26; T2, 139; T3, 121; T4, 49; cN0, 83; cN1, 61; cN2a-b, 118; cN2c, 71; cN3, 2) treated between 2006 and 2013 were retrospectively reviewed. There were 323 males and 12 females. Age aged from 36 to 80 years old with a median of 60 years old. There was no case with distant metastasis. All patients received modified neck dissection, including unilateral in 240 patients and bilateral in 95 patients. Pharyngoesophageal defects were reconstructed with directly suture in 246 cases, pectoralis major musculocutaneous flaps in 74 cases, and laryngotracheal flaps in 15 cases. Three hundred and nineteen patients received postoperative radiotherapy (55-65 Gy). Results: The overall 3 and 5 year survival rates were 68.6% (230/335) and 52.1%(139/267), respectively. The cervical lymph node metastases were found in 265 (79.1%) patients. Pathologic findings showed that all patients had squamous cell carcinoma. Laryngeal functions (voice, respiration and deglutition) were completely restored in 277 (82.7%) patients. Conclusions: The oncological efficacy of surgery via the paraglottic space approach is sure for pyriform sinus carcinoma, especially suitable for the early and medium-term lesions. The function of the larynx can retain after surgery, with the decreased incidences of cough and pharynx fistula.
目的：总结声门旁间隙入路梨状窝癌切除术的临床经验，分析其手术适应证及疗效。 方法：回顾性分析2006年1月至2013年12月山东大学齐鲁医院耳鼻咽喉头颈外科335例经声门旁间隙入路梨状窝癌切除手术的临床资料，所有患者均为首次手术。其中男性323例，女性12例；年龄36～80岁，中位年龄60岁。根据国际抗癌联盟(UICC)2012临床分期标准，Ⅰ期12例，Ⅱ期36例，Ⅲ期79例，Ⅳ期208例；肿瘤T分期为T1期26例，T2期139例，T3期121例，T4期49例。采用咽腔剩余黏膜缝合246例，胸大肌肌皮瓣修复74例，喉气管黏膜瓣代下咽食管15例。所有患者均行颈淋巴清扫术，淋巴结分期为cN0期83例，cN1期61例，cN2a－b期118例，cN2c期71例，cN3期2例。行单侧颈淋巴清扫术240例，双侧颈淋巴清扫术95例。Ⅰ、Ⅱ期患者术后未行放疗，随访复查，4例T3N0期患者拒绝放疗，其余患者术后均行辅助放疗(放射剂量55～65 Gy)。 结果：保留喉功能277例，喉功能保留率82.7%，术后病理证实淋巴结转移265例，淋巴结转移率79.1%。无围手术期死亡病例，11例术后出现咽瘘，咽瘘发生率3.3%，其中放疗过程中发生咽瘘2例。所有患者出院前顺利经口进食，拔除胃管。本组患者随访率为96.7%(324/335)，3年生存率为68.6%(230/335)，5年生存率为52.1%(139/267)。 结论：声门旁间隙入路切除梨状窝癌效果肯定，尤其适合早、中期病变患者，该手术方式可以有效保留喉功能，减轻术后进食呛咳，减少咽瘘的发生。.
Keywords: Carcinoma, squamous cell; Combined modality therapy; Hypopharyngeal neoplasms; Laryngectomy; Pharyngectomy.