不同手术方式治疗喉癌的远期疗效及其手术切缘组织中p53和c-myc蛋白的水平

Effect of long-term evaluation of different operation methods on laryngeal cancer and expression of p53 and c-myc in surgical margins

摘要:

目的探讨不同手术方式治疗喉癌的远期疗效及其手术切缘组织中p53 和c-myc 蛋白的表达水平。方法选取2007年12月-2011年12 月在该院接受治疗的74例喉癌患者作为研究对象，根据患者意愿将其分为对照组和观察组，每组各37 例，对照组给予全喉切除术治疗，观察组给予喉部分切除术治疗，对比分析两组患者术后血液炎症指标、手术切缘组织中p53 和c-myc 蛋白水平、喉功能恢复情况和并发症发生率、复发率、生存率及生活质量。结果术后7 d，对照组患者IL-6 和CRP 水平均高于观察组（P <0.05）；两组患者术后3 和5 年存活率比较，差异无统计学意义（P >0.05）；观察组患者随访期间复发率为21.62%，高于对照组5.41%（P <0.05）；观察组患者手术切缘组织中p53 蛋白阳性率为51.35%，高于对照组27.03%（P <0.05）；复发患者手术切缘组织中p53 蛋白阳性率高于未复发患者（P <0.05）；c-myc 蛋白阳性率在复发和未复发患者间以及观察组和对照组间，差异无统计学意义（P >0.05）；两组并发症发生率比较，差异无统计学意义（P >0.05）；观察组患者术后喉功能恢复情况优于对照组（P <0.05）；观察组患者娱乐、交流、吞咽、咀嚼及生活质量总得分均高于对照组（P <0.05）。结论与全喉切除术比较，喉部分切除术复发率较高，但对喉功能影响较小，且患者术后生活质量较高，手术切缘组织中p53 蛋白阳性检测对患者术后复发预测具有重要意义。

Abstract:

Objective To explore the effect of long-term evaluation of different operation methods on laryngeal cancer and the expression of protein p53 and c-myc in surgical margins. Methods A total of 74 cases of laryngeal cancer were treated in our hospital from December 2007 to December 2011, and divided into observation group and control group (37 cases in each group). The control group underwent total laryngectomy while the observation group was treated with partial laryngotomy. The postoperative inflammation indexes of blood, the levels of p53 and c -myc in surgical margins, recovery of laryngeal function,complication rate, recurrence rate, survival rate and quality of life were compared between the groups. Results Levels of IL-6 and CRP in the control group were higher than those in the observation group on the seventh day after surgery (P < 0.05). There were no significant differences in 3-year survival rate and 5-year survival rate after surgery in the groups (P > 0.05). The recurrence rate of the observation group was 21.62%, higher than that in the control group (5.41%) (P < 0.05). The positive rate of p53 in surgical margins of the observation group was 51.35%, higher than that in the control group (27.03%) (P < 0.05). There were no significant differences in the positive rate of c-myc in surgical margins between the observation group and the control group, and between recurrence and recurrence-free patients (P > 0.05). The complication rate between the groups had no significant difference (P > 0.05). The recovery of laryngeal function in the observation group was better than that in the control group (P < 0.05). The scores of entertainment, communication, swallowing,chewing and total score of life quality in the observation group were higher than those in the control group (P < 0.05). Conclusions The recurrence rate of partial laryngotomy is higher than that of the total laryngectomy; but the partial laryngotomy has little effect on the function of larynx and higher quality of life.Detection of positive p53 in surgical margins has a great significance in predicting recurrence.