内镜活检孔道注气法用于显露下咽癌患者食管入口处的临床研究

Display of esophageal entrance by injecting gas through the laryngoscopic biopsy channel inhypopharyngealcancer

目的探讨下咽癌内镜检查时食管入口处的显露方法，以提高喉镜对下咽癌侵犯范围判断的准确性。方法113例下咽癌患者术前均行喉镜检查及影像学检查，喉镜下食管入口的显露采用活检孔道注气法，与影像学检查对比，观察这种方法对下咽癌侵犯食管入口处的判断情况。卡方检验比较两种方法的显露情况。结果本组113例下咽癌患者常规喉镜检查均无法对食管入口处是否受侵犯做出判断。喉镜下使用活检孔道注气法后，96．5％（109／113）的病例能够清晰显露食管入口处，其中33例患者食管入口受侵犯，76例未见侵犯。而影像学仅发现25例食管入口侵犯。经统计学分析喉镜检查对食管入口是否受侵的判断优于影像学检查（x^2=9．103，P=0．003）。结论喉镜检查是下咽癌术前诊断的一种重要方法，使用活检孔道注气法可以显露食管入口处，从而明显提高下咽癌术前分期的准确性。

Objective To investigate the method displaying the hypopharynx and esophageal entrance under laryngoscopy to determine the invasion range of hypopharyngeal cancer. Methods A total of 113 patients with hypopharyngeal cancer was enrolled in this study and they previously underwent conventional laryngoscopie and radiologic examinations. The esophageal entrance was exposed by injecting gas through the biopsy channel of laryngoscope. The invasion of esophageal entrance in hypopharyngeal cancers was evaluated by this method and compared with that evaluated with radiology. Results Conventional laryngoscopy was unable to evaluate appreciably esophageal entrance involvement in the 113 patients with hypopharyngeal cancer. After injecting gas through the laryngoscopic biopsy channel, the esophageal entrance was clearly displayed in 96. 5% （109/113） patients, showing the presence （33 cases） and absence （76 cases） of esophageal entrance invasion. Imaging examinations only showed the invasion of the esophageal entrance in 25 patients of these patients, but did not in other 8 patients. Laryngoscopy with injecting gas through the biopsy channel was superior to radiological imaging examinations in determining the invasion of the esophageal entrance （x^2=9.103, P= 0.003）. Conclusion Laryngoscopy with injecting gas through the biopsy channel is a useful method for determining the presence or absence of esophageal entrance invasion in hypopharyngeal cancer prior to surgery.