喉腺样囊性癌侵袭神经的临床特征分析

Clinical characteristics of invasive nerves in adenoid cystic carcinoma of larynx

目的通过对既往诊治的喉腺样囊性癌进行分析总结,探究此种罕见的恶性肿瘤临床特点及其对神经侵袭情况分析,为临床诊治提供理论参考。方法收集首都医科大学附属北京同仁医院8例喉腺样囊性癌患者的病历资料进行总结分析,并回顾相关文献,分析其特点及临床特征。结果 8例患者平均随访时间37个月(12~120个月),6例患者存活,2例喉腺样囊性癌合并鳞状细胞癌患者死亡。平均年龄为53岁(16~65岁)。最常见的临床症状是声音嘶哑,其次是呼吸困难和异物感。其中声门下型4例(50%),声门上型3例(37.5%),声门型1例(12.5%)。发生侵犯神经者4例,均有喉上神经受累,其中3例同时出现喉返神经受累。结论发生喉上神经侵袭的患者多于喉返神经侵袭,同时声音嘶哑也可归因于喉上神经的功能障碍。喉腺样囊性癌对喉上神经和喉返神经侵袭与否的评估在术后辅助放疗治疗决策、疗效和预后中起着重要作用。

OBJECTIVE Adenoid cystic carcinoma of the larynx is a rare type of larynx carcinoma which has only a few related reports and researches. This study retrospectively analyzed 8 cases of adenoid cystic carcinoma of the larynx treated in our hospital, explored the clinical characteristics of this rare type of laryngeal malignant tumor and its neurological invasion, so as to provide theoretical reference for clinical diagnosis and treatment. METHODS Eight patients of laryngeal adenoid cystic carcinoma treated in Beijing Tongren Hospital of Capital Medical University were collected and analyzed. The relevant literature was reviewed, and the corresponding characteristics and clinical features were analyzed. RESULTS The average followup time of 8 patients was 37 months (12-120 months). Six patients survived and two patients died of adenoid cystic carcinoma of larynx combined with squamous cell carcinoma. The average age was 53 years (16-65 years). The most common clinical symptoms were hoarseness, followed by dyspnea and foreign body sensation. Subglottic type was found in 4 cases (50%), supraglottic type in 3 cases (37.5%) and glottic type in 1 case (12.5%). In 4 cases, SLN (superior laryngeal nerve) was involved, and RLN (recurrent laryngeal nerve) was involved in 3 cases. CONCLUSION The incidence of SLN invasion is higher than that of RLN invasion, the evaluation of invasion of SLN and RLN in adenoid cystic carcinoma of larynx plays an important role in decision-making, efficacy and prognosis of adjuvant radiotherapy after operation.