梨状窝癌致半喉固定的机理及其意义

On the mechanism of hemilaryngeal fixation in pyriform sinus carcinoma and its clinical significance

为了探讨梨状窝癌产生半喉固定的机理，对４３例梨状窝癌全喉下咽切除标本进行了次连续切片的组织病理学研究。指出梨状窝癌产生半喉固定的主要原因是癌组织通过声门旁间隙侵犯喉内肌和杓状软骨外上方。如梨状窝内侧壁有癌瘤存在，则癌易向喉内结构侵犯引起半喉固定。临床Ｔ３病变易侵犯喉软骨和邻近软组织而成为病理Ｔ４。随着声带活动受限程度的增加，保留喉手术的可能性逐渐下降，也说明半喉固定是梨状窝癌侵犯喉内结构的重要临床标志。为彻底切除半喉固定的梨状窝癌，仍以全喉切除较为安全可靠。

To approach the mechanism of hemilaryngeal fixation in pyriform sinus carcinoma (PSC), surgical specimens from total laryngectomy and partial hypopharyngectomy in 43 cases of pyriform sinus carcinoma were studied using organ subserial sections. Invasion of intralaryngeal muscles and the upper and outer aspects of arytenoid cartilage via paraglottic space was found to be the main cause of hemilaryngeal fixation in these cases. Presence of tumor on the medial wall of the pyriform sinus makes involvement of intralaryngeal structures easy, and thus is more frequently seen with hemilaryngeal fixation. Clinical T 3 lesion of the sinus may infiltrate laryngeal cartilages and adjacent soft tissue to become pathologic T 4 lesion. For PSC appearing hemilaryngeal fixation, total laryngectomy is safer to thoroughly remove cancer.