对贯声门癌再认识的临床意义

Recognizing of the transglottic carcinoma

目的 :进一步探讨贯声门癌临床存在的意义。方法 :分析 86例贯声门癌的临床表现、手术、颈转移、组织病理学研究及随访资料。结果 :贯声门癌有别于声门上、声门型喉癌 T2 、T3期。其中行全喉切除术 6 3例 ,次全喉 9例 ,扩大垂直半喉 14例 ;同期行颈廓清术 47例。术中见 ,>2 cm的贯声门癌 5 8%侵及喉骨架 ,46 %扩展至喉外 ,以及 71%的颈转移。随访 5年生存率 5 5 .4% ,10年 2 9.7% ,≥ 15年 18.9%。结论 :贯声门癌作为临床的一种特殊类型有实际意义 ;声门旁间隙的局部解剖特点是导致贯声门癌易广泛扩展和颈转移的原因 ;对贯声门癌的治疗原则应是在手术同时行选择性颈廓清 ,术后补充放疗。

Objective:A study was undergone about transglottic carcinoma(TGC) in eighty six cases from 1979 to 1998, so as to recognize the TGC.Method:Evaluating retrospectively the procedure of the disease,surgical operations,presence of cervical metastasis,gathering the data on histopathological discovery and following up and so on. Result:The TGC was different from T 2、T 3 supraglottic or glottic carcinoma of larynx. In 86 TGC, there were 63 cases which were operated with total laryngectomy,9 cases subtotal laryngectomy and 14 cases frontolateral hemilaryngectomy,47 cases with neck dissection. In TGC which size >2 cm,there were 58% which extend to the framework of larynx,46% with extension out of larynx,and 71% with neck metastasis.The result of following up shows that 5 year survival rate was 55.41 %,10 year was 29.72 %,15 year and more was 18.92 %. Conclusion:There is an actual signification for TGC to be a special type of the laryngeal carcinoma. The characteristics of the precise topography of the the paraglottic space(PGS) can explain the reason of extension ,spread of the TGC and cervical metastasis. Elective neck dissections and complemental radiotherapy postoperatively should be included during surgical resection.