梨状窝癌向邻近组织结构侵犯规律的组织病理学研究

Histopathological study on the regularity of pyriform sinus carcinoma invading adjacent tissue and structure

目的探讨梨状窝癌侵犯邻近组织的规律。方法对68例梨状窝癌全喉或部分喉及下咽切除整体标本连续切片进行组织病理学研究。结果 68例梨状窝癌中室、声带水平声门旁间隙受侵分别为63、38例,其受侵频度差异有统计学意义(x^2=21.37,P<0.01);甲状软骨受侵频度最高,为92.6%(63/68),喉软骨触压式侵犯89例次,浸润式51例次,浸润范围明显小于触压范围;环杓侧肌、环杓后肌、甲杓间和杓间肌受侵频度分别为63.2%(43/68),57.4%(39/68),55.9%(38/68),51.5%(35/68);环杓关节和环甲关节受侵频度分别为31.0%(21/68),17.6%(12/68)。喉上神经侵犯频度67.7%(44/65)多于喉返神经27.7%(18/65)。梨状窝内壁(为主)癌14例,外壁(为主)癌18例,内外壁癌36例;梨状窝尖受侵34例,正常26例,黏膜下浸润8例;梨状窝癌淋巴细胞轻度浸润为66.2%(45/68),最多见。梨状窝癌黏膜下侵犯24例和跳跃式浸润8例。结论梨状窝癌对喉内的侵犯首先通过声门旁间隙;喉软骨膜和喉软骨可抵抗癌侵犯;环杓侧肌、环杓后肌、甲杓间和杓间肌经常受侵;梨状窝内壁癌可侵犯喉内结构,外壁癌可沿甲状软骨内壁向上、下、外侵犯,内外壁癌可同时侵犯喉内、外结构,是最严重的梨状窝癌病变。梨状窝尖侵犯是癌向下咽下方及邻近组织侵犯的重要标志。

Objective To explore the regularity invading adjacent tissue of pyriform sinus carcinoma. Methods The whole organ serial section of 68 total or partial laryngectomy and hypopharyngectomy specimen of pyriform sinus carcinoma were histopathologically studied. Results In 68 pyriform sinus carcinoma, invaded ventricular and paraglottic spaces was 63 and 38 cases respectively, the difference of invasive frequency of both spaces was significantly marked （ x^2 = 21.37, P 〈 0.01 ） . Thyroid cartilage had the most invaded frequency of 92. 6% （63/68）. The all touching and pressing invasion of laryngeal cartilage was 89 times, and infiltrating invasion was 51 times. The invasive frequency of lateral cricoarytenoid muscle, posterior cricoarytenoid one, thyroarytenoid and interarytenoid ones were 63.2% （43/68） ,57.4% （ 39/68 ）, 55.9% （ 38/68 ）, 51.5% （ 35/68 ） respectively. The invasive frequency of cricoarytenoid and cricothyroid joints were 30.9% （ 21/68 ）, 17.6% （ 12/68 ） respectively. The invasive frequency of superior laryngeal nerve was 67.7% （44/65）, and more than that of recurrent laryngeal nerve （ 18/65,27. 7% ）. The pyriform sinus medial wall carcinoma was 14 cases, lateral wall carcinoma 18 cases, medial and lateral wall carcinoma 36 cases. The invaded pyriform sinus apex was 34 cases, normal its apex was 26 ones, submucous invasion of its apex was 8 ones. Light lymphocytic invasion was 66. 2% （45/68） and seen most in pyriform sinus carcinoma . Submucous and leaping invasion of pyriform sinus carcinoma were 24 and 8 cases. Conclusions Intralaryngeal invasion of pyriform sinus carcinoma arose through paraglottic space first. Laryngeal cartilage membrane and their cartilage were anatomical obstacle against cancerous invasion. Lateral cricoarytenoid muscle, posterior cricoarytenoid one, thyroarytenoid and interarytenoid ones were often invaded. Pyriform sinus medial wall carcinoma invaded intralaryngeal structure easily, its lateral wall carcinoma may invade upward, downward and outward along thyroid cartilage interior wall, medial and lateral wall carcinoma may invade intralaryngeal and extralaryngeal structure, and was the most serious lesion. The invasion of pyriform sinus apex is an important sign of pyriform sinus carcinoma spreading downward to inferior and peripheral tissues of hypopharynx.