贯声门癌临床与组织病理学研究

A Clinical and Histopathological Study of Transglottic Carcinoma

目的 通过近 2 0年对 86例贯声门癌的临床和组织病理学研究 ,进一步探讨贯声门癌临床存在的意义。方法 分析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。 86例贯声门癌做全喉切除术 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。 >2cm的贯声门癌 5 8%侵及喉骨架、46 %扩展至喉外以及 71%的颈转移率。随访结果 ,5年生存率5 5 .41% ,10年 2 9.72 % ,15年及以上 18.92 %。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 。

Objective To make a clinical and histopathological study on transglottic carcinoma (TGC) so as to give a better recognition of TGC. Methods 86 patients in this hospital from 1979 to 1998 were analyzed retrospectively on their clinical features, surgical operations, presence of cervical metastasis, their histopathological data, follow up study, and so on. Results The TGC was different from T2?T3 supraglottic or glottic carcinoma of larynx. In 86 TGC operations, there were 63 total laryngectomy cases, 9 subtotal laryngectomy cases, and 14 frontolateral hemilaryngectomy cases, 47 cases with neck dissections. In>2 cm TGC, there were 58% cases which extended to the framework of larynx, 46% cases with extensions across the larynx, and 71% cases with neck metastasis. As to the results of follow up, 5 year survival rate was 55.41%, 10 year ,28.72%, and 15 or more year , 18.92%. Conclusion There is an actual signification for TGC to be a special type of laryngeal carcinoma. The characteristics of the precise topography of paraglottic space (PGS) can be explained the reason of extension, spread of TGC and cervical metastasis. Elective neck dissections should be included during surgical resection and complemental postoperative radiotherapy should be done.