舌骨下肌瓣会厌重建治疗喉声门上型癌

喉声门上型癌以手术治疗为主,手术以后因会厌缺失易引起吞咽功能障碍,我们自1996年1月至2002年2月,对23例喉声门上型癌进行舌骨下肌皮瓣会厌重建手术治疗,效果良好,总结如下。     

会厌下移一期重建声门治疗声门癌

本文报道用会厌下移一期重建声门术（Ｔｕｃｋｅｒ术）治疗双声带受侵犯的声门癌３１例，结果证明此手术不仅能彻底切除肿瘤，而且能有效的保存喉的发声、呼吸和吞咽保护功能，３年生存率８１．５％（２２／２７），降低了致残率及复发率，改善了患者的生存质量，故认为该术式是治疗双声带受侵的声门癌的一种较理想术式，值得推广使用。     

显微支撑喉镜下治疗会厌囊肿的疗效分析

会厌囊肿是耳鼻咽喉科的常见病,患者大多因咽部异物感就诊或体检时发现.如囊肿继发感染可表现为喉部疼痛,可出现咳嗽或声音改变,严重者可致喉阻塞.目前临床手术治疗方式主要包括:常规器械切除、高频电刀、微波、激光、低温等离子刀等.我科常规采用全麻显微支撑喉镜下切除术,虽然术中出血相对上述热器械手术多,但术中创伤小,术后恢复快.近年来我们对直径超过1.5 cm的会厌囊肿行囊肿揭盖术,较以往囊肿完整摘除术相比,效果更佳,报道如下.     

支撑喉镜下超声刀切除会厌囊肿

目的探讨支撑喉镜下超声刀切除会厌囊肿的临床应用。方法对我科2008年2月～2009年8月收治的86例会厌囊肿患者,按照随机数字表法随机分为治疗组43例,对照组43例,两组均在支撑喉镜下进行。治疗组采用超声刀治疗,对照组采用高频电刀手术切除并比较其临床疗效。结果治疗组出血明显减少、手术时间明显缩短、术后疼痛减轻,两组术后均无复发。对照组有2例术后会厌部分缺损。结论支撑喉镜下超声刀手术治疗会厌囊肿有手术时间短,术中极少出血,术后疼痛轻,并发症少,复发率低等优点。     

电子喉镜下氩气刀切除会厌囊肿

目的　探讨电子喉镜下氩气刀切除会厌囊肿的临床疗效。方法 回顾性分析2014年1月~2018年9月80例会厌囊肿患者经电子喉镜下氩气刀切除的临床资料,所有患者均在表面麻醉下完成手术。结果 80例会厌囊肿患者一次性完整切除病变,术中出血量少,手术时间5~30分钟,术后无发热、出血、呼吸困难、感染等并发症。随访3~36个月,无复发病例。结论 电子喉镜下氩气刀切除会厌囊肿,电子喉镜可放大手术视野,手术视野清晰,可多角度观察无死角,氩气刀对组织损伤小,出血少基本达到无血操作,手术时间短,术后反应轻,恢复快,手术效果确切,无须全身麻醉,就医成本低,值得临床推广。     

Nd:YAG激光声带切除术治疗声带癌

目的探讨支撑喉镜下NdYAG激光声带切除术治疗声带癌的疗效.方法 为13例声带癌患者行气管切开插管静脉复合麻醉,T1a用NdYAG激光切除单侧声带,安全边缘可跨越前联合,T1b可同时切除双侧声带及前联合组织.结果无手术并发症,随访8～23个月,患者均呼吸平稳,喉内瘢痕光滑,声门裂≥8 mm.结论支撑喉镜下NdYAG激光声带切除术治疗声带癌可行.     

多层螺旋CT在诊断颈部肿瘤中的应用

目的：探讨多层螺旋 ＣＴ（ＭＳＣＴ）在颈部肿瘤病变中的应用价值。方法：应用 Ｌｉｇｈｔ Ｓｐｅｅｄ ＱＸ／ｉ型 ＭＳＣＴ检查３２例颈部肿瘤患者（喉癌３０例,颈段食管癌１例,甲状腺癌１例）,行三维重建及仿真内窥镜成像。结果;ＭＳＣＴ图像清晰,矢状面图像可显示会厌癌侵犯会厌前间隙、声带及声门下的情况以及有无侵犯甲状软骨达颈前软组织;冠状面图像可显示声门旁间隙、杓会厌皱襞及梨状窝受侵情况,并可显示甲状腺癌压迫并侵犯喉及气管情况,多平面重组配合增强扫描可显示转移淋巴结大小、数目与颈部血管关系等。结论：ＭＳＣＴ对术前明确肿瘤范围,行ＴＮＭ分期及正确选择手术术式有一定帮助。     

支撑喉镜下声门暴露困难患者声带病变的处理

2001年Kawaida等报道在支撑喉镜电视显示下进行喉部良性病变手术并取得良好效果。然而对于肥胖、颈部短粗、前突型深覆颌、牙列严重不齐且咽反射极其敏感的患者,支撑喉镜暴露病变有困难。此时结合纤维喉镜或30。鼻内镜,可以较好的暴露病变,从而施行手术。近年来我们采用支撑喉镜引导下纤维喉镜或鼻内镜辅助技术,治疗声门暴露困难的声带息肉患者,疗效良好。现报道如下。     

喉部分切除术后喉囊肿

目的探讨喉部分切除术后喉囊肿的发病率、病因、临床特点、诊断及治疗方法。方法回顾性分析2003年1月～2009年6月北京同仁医院收治的228例颈外入路喉部分切除术患者的诊疗及随访情况,并对喉部分切除术后喉囊肿进行分析报道。结果随访中发现2例喉囊肿,均为喉部分切除会厌成形术后。1例于术后20个月发现囊肿位于会厌舌面,行支撑喉镜下CO2激光切除囊肿。另1例术后19个月发现囊肿位于声门下区,经颈外入路切除。结论喉部分切除术后喉囊肿并不常见,可能与会厌前间隙分离过程中黏膜上皮种植有关。CT或MRI有助于诊断。囊肿可于支撑喉镜下或经颈外入路行手术切除。     

支撑喉镜下电凝切除会厌囊肿12例

目的探讨利用电凝钩在支撑喉镜下切除会厌囊肿的可行性及治疗效果。方法使用电凝钩在支撑喉镜下对12例会厌囊肿患者进行了手术治疗,术后随访6～12个月。结果手术均一次性完成,无手术并发症。术后随访6～12个月均无复发。结论采用电凝钩在支撑喉镜下切除会厌囊肿具有疗效佳,损伤小,无并发症等优点。     

支撑喉镜下超声刀切除会厌囊肿的临床体会

目的探讨支撑喉镜下超声刀切除会厌囊肿的麻醉方法、手术效果,总结经验及体会。方法回顾性分析2013年1月～2015年1月诊治的42例会厌囊肿患者的临床资料,所有患者均全身麻醉下采用超声刀切除会厌囊肿,术后随访1年,行电子喉镜检查进行疗效评价。结果41例患者均达到治愈,1例出现会厌萎缩。结论超声刀切除会厌囊肿出血少,视野清晰,手术时间短,但术中操作应仔细,避免大面积热损伤而出现术后患者疼痛、会厌萎缩的可能。     

Endoscopic supraglottic laryngectomy: a proposal for a classification by the working committee on nomenclature, European Laryngological Society

In July 1999, the European Laryngological Society (ELS) has accepted a proposal for the classification of different laryngeal endoscopic cordectomies. This is actually a common classification system used as a tool for surgical training, documentation and comparison of results. The same harmonization work is deemed necessary for the treatment of supraglottic lesions. The ELS is proposing a classification of the different laryngeal endoscopic supraglottic partial laryngectomies. This classification comprises four types of supraglottic laryngectomies: Type I, limited excision of small size superficial lesions of the free edge of the epiglottis, the ary-epiglottic fold, the arytenoid, or the ventricular fold or any other part of the supraglottis; Type II, medial supraglottic laryngectomy without resection of the pre-epiglottic space, suitable for T1 lesions of either the suprahyoid or the infrahyoid laryngeal surface of the epiglottis (Type IIa, superior hemi-epiglottectomy or Type IIb, total epiglottectomy, respectively); Type III, medial supraglottic laryngectomy with resection of the pre-epiglottic space, suitable for T1–T2 tumors of the infrahyoid endolaryngeal epiglottis without (Type IIIa) or with (Type IIIb) extension to the ventricular fold, necessitating its excision; finally, Type IV, lateral supraglottic laryngectomy, suitable for tumors of the threefolds’ region, which may include the ventricular fold (Type IVa) or the arytenoid (Type IVb), when involved. As in the cases of endoscopic cordectomies, these operations are similarly classified according to the surgical approach used and the degree of resection completed in order to facilitate their use in daily clinical practice.     

KTP激光治疗喉癌的远期疗效

目的: 探讨支撑喉镜下KTP激光治疗喉癌的远期疗效。方法: 对108例支撑喉镜下KTP激光手术治疗的喉癌患者,将其资料进行回顾性分析,其中声门型T1a87例,T1b17例,T22例,声门上型T12例。结果: 108例患者中失访7例,随访的101例患者中局部复发3例,转移4例。结论: 激光治疗早期喉癌疗效满意,喉功能保全好;局部复发的病例仍可采取挽救性治疗。     

Cervical metastasis of occult papillary thyroid carcinoma associated with epidermoid carcinoma of the larynx.

An occult, laterocervical papillary thyroid carcinoma tissue was found in a functional neck dissection for larynx cancer. The patient was a 76-year-old man with a history of smoking and alcohol ingestion who presented with a supraglottic carcinoma of the larynx located at the laryngeal surface of the epiglottis, left aryepiglottic fold, band and left ventricle with extension to the left vocal cord. Light microscopy showed a lymph node with a fibrous stroma with lymphoid follicles that presented a total substitution of the parenchyma by a papillary thyroid carcinoma. Although examination of the thyroid gland by seriated sections did not reveal any neoplasm, we argue that the papillary thyroid tissue is metastatic.     

Transglottic carcinoma: a histopathological study of 64 cases]

Sixty-four cases of the transglottic carcinoma treated with surgical operations at our hospital were reviewed. The anatomical sites and the serial sections of the tumour specimens were observed. It indicated that 42 cases were proved to be supraglottic carcinomas; 7 glottic; 5 subglottic. Ten cases had no definite primary sites. There was no T1 lesion and only one pT2 lesion. 98.4% of the specimens showed pT3-pT4. 75% specimens lesions greater than or equal to 2 cm. Thus we suggest that the so called transglottic carcinoma should be regarded as an advanced lesion of the laryngeal cancers. The advanced cancers can spread into the paraglottic space and invade the laryngeal frame-works as a special pathological features. The paper also discussed the primary site of the transglottic lesion. We think that it is reasonable to classify the laryngeal cancers into supraglottic, glottic and subglottic categories. The idea to classify tumours that originate in the ventricle into an independent type, i.e. transglottic carcinoma, will wait for further discussions.     

Epiglottic reconstruction after supraglottic laryngectomy.

It has been well established that supraglottic laryngectomy is an effective treatment of laryngeal cancer arising above the vocal cords with cure rates equaling total laryngectomy. Although there is preservation of a near normal voice after supragloltic laryngectomy, chronic aspiration occurs in some patients particularly after extended supraglottic laryngectomy or when there is associated compromised pulmonary function. During normal deglutition, the epiglottis serves to divert food to the pyriform fossae and partially covers the inlet to the airway. These important functions can be accomplished after supraglottic laryngectomy by reconstructing a neoepiglottis from an epiglottic remnant whenever one third or more of the epiglottis can be preserved which is microscopically free of tumor. Our results in 14 patients have shown no clinically significant aspiration after epiglottic reconstruction.     

环状软骨上喉次全切除术后喉功能的临床分析

目的分析喉鳞状细胞癌患者接受环状软骨上喉次全切除(supracricoid partial laryngectomy,SCPL)术后喉功能的情况。方法回顾性分析2000~2006年采用SCPL治疗喉鳞状细胞癌患者38例,其中声门上型17例,声门型21例;术后辅助放射治疗8例,剂量累计为60~65 Gy。对切除(或)保留会厌、保留一侧(或)双侧杓状软骨患者术后呼吸、发音、吞咽功能分别进行评估。所得结果运用统计学方法进行检验。结果所有患者随访至今,无失访;3年生存率81.6%,5年生存率73.7%。其中声门上型喉癌3年生存率76.5%,5年生存率64.7%;声门型喉癌3年生存率85.7%,5年生存率81.0%。所有患者均拔除气管套管,拔管率为100%。切除会厌和一侧杓状软骨患者的误咽评分、平均气管套管拔除时间、平均鼻饲胃管拔除时间和平均住院天数均高于其他组,差异具有统计学意义;而呼吸、发音评估各组之间比较差异无统计学意义。结论 SCPL对喉癌治疗和喉功能保留有积极意义,临床分析表明会厌和一侧杓状软骨切除对于患者远期喉功能恢复无影响。     

Occult metastases from T1–T2 supraglottic carcinoma: role of primary tumor localization

The present study was undertaken to evaluate the role of localization on the rate of occult metastasis in early stage supraglottic laryngeal carcinoma. We selected carefully 32 T1–2 clinically N0 patients without epilarynx involvement and 39 T1–2 clinically N0 patients with epilarynx involvement from among patients with supraglottic laryngeal carcinoma. All patients underwent simultaneous unilateral or bilateral neck dissection with laryngeal surgery. The rate of the occult metastases was 3.1% in patients without epilarynx involvement, whereas it was 20.5% in patients with epilarynx involvement. Within the supraglottic larynx, two subregions can be distinguished: the epilarynx and the lower supraglottis. Our results suggest the possibility of omitting elective neck treatment in T1–2N0 supraglottic laryngeal carcinoma without epilarynx involvement. Observation under strict follow-up may be an option to routine neck treatment in T1–2N0 supraglottic laryngeal carcinoma without epilarynx involvement.     

Supracricoid laryngectomy with cricohyoidopexy: a partial laryngeal procedure for selected supraglottic and transglottic carcinomas

The partial horizontal supracricoid laryngectomy with cricohyoidopexy consists of resection of the whole thyroid cartilage and paraglottic space, as well as the epiglottis and the whole pre-epiglottic space. The cricoid cartilage, the hyoid bone, and at least one arytenoid cartilage are spared. Sixty-eight patients with squamous cell carcinoma of the supraglottis who underwent this procedure during the period from 1974 through 1986 are presented. Conventional horizontal supraglottic laryngectomy was contraindicated in all cases. All but three patients (95.4%) recovered physiologic deglutition, and none required a permanent tracheostomy. The 3-year actuarial survival rate was 71.4%. No local recurrences were encountered. The indications for the procedure are carcinomas of the supraglottis that 1. involve the glottis and anterior commissure, 2. invade the ventricle, 3. present with a marked limitation of true vocal cord mobility (transglottic lesions), and 4. invade the thyroid cartilage. The procedure is presented as a useful alternative to radiation therapy, horizontal supraglottic laryngectomy, and total laryngectomy in select cases of supraglottic carcinoma.     

The supraglottic nerve supply: an anatomic study with clinical implications

OBJECTIVES: To describe the course of the superior laryngeal nerve (SLN) and its branches, in particular, with regard to supraglottic motor and sensory functions. METHODS: In 30 normal human hemilarynges, the SLN with its internal (intSLN) and external branch (extSLN) were dissected under microsurgical conditions and marked with acrylic dye. All anatomic structures of the larynges (muscles, cartilages, and ligaments) were dissected in detail. RESULTS: The intSLN subdivides into three branches. The superior branch (I) runs to the lingual (extralaryngeal) part of the epiglottis and sends small fibers through the epiglottic foramina to the laryngeal surface. The middle branch (II) runs through the aryepiglottic fold into the ventricular fold, and the inferior branch (III) to the piriform sinus and to the postcricoid region, forming various anastomoses (e.g., ansa galeni) with the recurrent laryngeal nerve (RLN). The extSLN runs to the cricothyroid muscle (CT) and sends a branch through the CT along the lower rim of the thyroid cartilage into the larynx and up to the ventricular fold. This ventricular branch is a potential candidate for the innervation of the ventricular muscle (VM). CONCLUSIONS: Our results may contribute to a better understanding of supraglottic actions that provide primary functions of the larynx (such as swallowing, coughing, and breathing). An enhanced knowledge of neurolaryngology also provides a basis for interpreting disorders or paralyzes following surgical treatments (e.g., thyroid surgery, partial laryngectomy) and helps to lower the risks.