梨状窝癌局部扩展的病理学研究

目的　探讨梨状窝癌局部扩展的规律 ,为梨状窝癌的手术治疗提供病理学依据。方法　应用石蜡包埋大体标本连续切片的方法 ,对 2 6例梨状窝癌全喉及次全喉切除的标本进行了观察。结果　位于梨状窝外侧壁的肿瘤 ( 4例 )主要向外侧咽侧壁扩展 ,位于梨状窝内侧壁的肿瘤 ( 5例 )容易向喉腔及对侧梨状窝扩展。累及整个梨状窝 17例。声门旁间隙及甲状软骨是最易受侵犯的喉结构 ,环状软骨受侵较少 ;会厌及会厌前间隙的侵犯未见超过中线 ,声门旁间隙及会厌前间隙的侵犯途径有2个 ,肿瘤沿杓会厌襞向前及在甲状软骨板内侧直接向前侵犯声门旁间隙 ;肿瘤沿杓会厌襞向内上方及在甲状软骨板内侧上部侵入会厌前间隙。结论　会厌前间隙的受侵并不是喉部分切除的禁忌证 ,大部分位于梨状窝外侧壁的肿瘤及部分梨状窝内侧壁的肿瘤保留喉功能是可行的 ;位于梨状窝内侧壁及环后区的肿瘤易在环后区向对侧侵犯 ,对累及环后区的梨状窝癌 (Ⅰ ,Ⅲ型 ) ,应注意肿瘤在环后区粘膜下向对侧侵犯。

Histological study of the local-regional invasion of pyriform sinus carcinoma

Objective In order to offer the basis for the operation of the pyriform sinus carcinoma , the local regional invasion patterns of the pyriform sinus carcinoma were investigated. Methods Twenty six surgical specimens obtained from patients who undergone laryngopharyngectomy were subjected to a whole organ section study. Results Tumors located in the lateral wall of the pyriform sinus spread mainly towards the lateral wall of the hypopharynx. Tumors located in the inner wall of the pyriform sinus spread mainly towards the larynx and opposite side pyriform sinus, the paraglottic space and thyroid cartilage were particularly frequent invaded. It was rare of the invading of the cricoid cartilage. The invasion of the epiglottis and preepiglottic space across the midline had not been found. There were two invading routines, the paraglottic space and preepiglottic space. The invasion of the paraglottic space was through the aryepiglottic fold and the inner surface of the thyroid cartilage. The invading of the preepiglottic space was through the aryepiglottic fold and the upper part of the inner surface of the thyroid cartilage. Conclusions The invading of the preepiglottic space was not the contraindication of the partial laryngectomy . It is practicable to preserve the laryngeal function in most of the patients while tumors located on the lateral or inner wall of the pyriform sinus. There was a tendency to the invading to the contralateral side in the inner wall of the pyriform or postcricoidarytenoid region. Attention should be paid to the submucosal spreading in the postcricoidarytenoid region.