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目的 :探讨喉癌术后局部复发与手术切缘的关系。方法 :对 1991～ 1999年行手术治疗并随访满 3年以上的喉癌患者的临床资料进行回顾性分析 ,分别选取手术切缘、T分期和术后放疗等因素进行统计学分析。结果 :① 16 0例喉癌患者术后局部复发 36例 ,复发率为 2 2 .5 % ;②局部复发与肿瘤的T分期有关 ,差异有统计学意义 ;③切缘≤ 3mm组的局部复发率高于切缘 4～ 5mm组和 >5mm组 ,差异有统计学意义 ;④手术切缘≤3mm的 6 9例中 ,32例行术后放疗的局部复发率低于 37例未行放疗者 ,差异有统计学意义 ;⑤声门型喉癌 5mm的手术切缘与切缘≤ 3mm组相比 ,局部复发率较低 ,差异有统计学意义。而 5mm的手术切缘对声门上型喉癌不够安全 ,与≤ 3mm组相比 ,局部复发率相似 ,差异无统计学意义。结论 :①以 5mm作为声门型喉癌的手术切缘是相对安全的 ;②以 5mm作为声门上型喉癌的手术切缘不够安全 ,如局部条件许可 ,建议以 10mm为安全切缘 ;③对手术切缘不够者行术后放疗可降低局部复发率 ,但不主张因此而放宽对安全切缘的标准。
Objective: To investigate the relationship between the local recurrence of laryngeal cancer and surgical margin. Methods: The clinical data of patients with laryngeal cancer who underwent surgical treatment from 1991 to 1999 with a follow-up of more than 3 years were retrospectively analyzed. Surgical margin, T stage and postoperative radiotherapy were selected for statistical analysis. Results: ①A total of 160 cases of laryngeal carcinoma were locally recurred in 36 cases, the recurrence rate was 22.5%. ② The local recurrence was related to the T stage of the tumor, the difference was statistically significant. ③ The local recurrence The rate was higher than the margin of 4 ~ 5mm group and> 5mm group, the difference was statistically significant; ④ surgical margin ≤ 3mm 69 cases, 32 cases of postoperative radiotherapy local recurrence rate was lower than 37 cases without radiotherapy , The difference was statistically significant; ⑤ 5mm margin of the glottic cancer laryngeal margins and margin ≤ 3mm group, the local recurrence rate was lower, the difference was statistically significant. However, the margin of 5 mm was not safe enough for supraglottic laryngeal carcinoma. Compared with ≤3 mm group, the local recurrence rate was similar, but the difference was not statistically significant. Conclusions: ① Surgical margins with 5mm as the glottic laryngeal carcinoma are relatively safe. ② Surgical margins with 5mm as the supraglottic carcinoma are not safe enough. If the local conditions permit, it is recommended to use 10mm for the margin of safety; ③ The surgical margin is not enough to perform postoperative radiotherapy can reduce the local recurrence rate, but do not advocate the consequent relaxation of the safety margin of the standard.