12例同时性多灶性喉癌的临床分析

A Clinical Analysis of 12 Patients with Synchronous Multifocal Laryngeal Carcinomas

目的本文报道了12例同时性多灶性喉癌并通过分析其临床病理学特点,探讨多灶性喉癌的发生学来源。方法回顾性分析1991～2001年间我院行全喉切除术的12例同时性多灶性喉癌的 TNM 分期、肿瘤位置、大小、组织学类型、病理学分级以及病史等。结果同时性多灶性喉癌的发病率是1.4%(12/861)。所有病理均为鳞状细胞癌。同一病例各病灶的组织学类型和病理学分级均相同。二病灶喉癌的发生率占总数的91.7%(11/12),仅一例为三病灶喉癌、67%(8/12)患者中二病灶分别位于双声带游离缘的对应处。3例(25%)有术前放疗史,1例术前曾行多次声带活检为不典型增生。所有病例术前均未诊断出多灶性。结论声门型同时性多灶性喉癌可能为单中心起源。腔内种植即声带振动时癌细胞从一侧声带游离缘种植到对侧接触损伤处,可能是喉癌多灶性的原因之一,放疗可能是多灶性喉癌的诱发因素。

Purpose The purpose of the study was to report 12 patients with synchronous multifocal laryngael cancers and analyze the possible carcinogenesis by their chnicopathological features.Methods To analyze the TNM staging,tumor location,tumor size,histological type,,pathological grading,and history of 12 cases of synchronous multifocal laryngeal carcinomas operated by total laryngectomy between 1991 to 2001 in our hospital.Results The incidence of synchronous multifocal laryngeal carcinomas was 1.4%(12/861).All of them were squamous cell carcinomas.The histological type and pathological grading of different focuses in each patient were the same.The rate of two-focus cancer was 91.7%(11/12), and only one case was a three-focus tumor.The two focuses of sixty-seven percent(8/12)of the patients were located separately in the opposed part of vocal cords which vibrate and contact each other frequently.Three patients(25.0%)had a history of radiotherapy,and one had several biopsies for dysplasia of vocal cords.None of the patients were found multifocal before surgery.Conclusion The carcinogenesis of synchronous multifocal laryngeal carcinoma might be one-center origin. The intralaryngeal implantation by vibration or contact of each vocal cords might be one of the causes of multifocal laryngeal cancer.Irradiation might be one of the induced factors.