声带癌前疾病及癌前病变与早期声门癌的动态喉镜表…

本文报告了声带癌前疾病及癌前病变２９例，早期声门癌（原位癌，Ｔ１及Ｔ２）２１例。动态喉镜下的基本表现（如声带粘膜波，振幅，声门闭合及襞裂运动状况），于两类病变有明显区别，结合病理检查，可以早期确诊，为治疗方案的选择提供依据。     

声门下癌的临床及病理分析

本文将１９７８－１９９０年临床、病理及随访资料完整的１５例声门下型喉癌病例进行回顾性分析。整喉以冠状切面行冠状连续切片，对其进行病理组织学研究，并结合临床分析，阐明：（１）声门下癌具有发病率低、病程长、发现晚的特点；（２）声门下鳞癌的生长方式主要为浸润生长及丛生浸润型生长，病理分组为Ⅱ、Ⅲ级，病理分期为Ｐ３、Ｐ４；（３）声门下癌局限于声门下区而不向声门上扩展，侵及甲杓肌致声带固定，并经环甲膜向喉外     

垂直喉部分切除术(PVL)治疗早期声门癌

早期声门癌指肿瘤起源于声门、声带活动正常、朱固定（Ｔ１和Ｔ２级归于此类）。放疗或行保留喉功能手术治疗为其主要方法,但其治疗方案仍有争论。该文作者自１９８０年～１９９５年对４９例早期声门癌行ＰＶＬ治疗。４８例病人术后拔管后无不适;１例病人拔管后呼吸困难...     

早期声门癌行声带切除术的适应症及疗效

早期声门癌属地，典型者为一侧声带中份的局限小癌肿，但可波及前连合或双声带，却未侵及声门F区、喉室、室带，且声带动度正常。其处理方法仍有争论，曾采用单纯放疗、经内窥镜行声带切除及经喉裂开术行声带切除术等。为探讨两种声带切除术径路处理早期声门癌的指征和疗效，对95例进行了回顾性研究，本组不包括典型额侧或垂直半喉切除、局部病变切除和放疗后复发病例，术前均未有放疗史。计男88，女7，平均67岁（27．＜～84．5）。原位癌12例，侵袭性癌83例（I级13例，I级59例，三级10例，N级1例）。3《例经内镜切除声带病变（23例用显微…     

跨声门癌50例观察

为确立一种原发喉室的跨声门癌，选择肿瘤主体以喉室为中心经全喉切除手术的标本５０例，火棉胶包埋，连续切片观察。结果发现（１）跨声门癌的肿瘤原发部位在喉室，５０例中有Ｔ２３例。（３）肿瘤以深层浸润为主占９０％（４５／５０），易侵及声门旁间隙（８２％，４１／５０）和甲状软骨（６４％，３２／５０），临床分期与病理分期不符达４８％（２４／５０），结论：原发喉室的跨声门癌是声门上型癌的一种特殊类型     

跨声门癌50例观察

为确立一种原发喉室的跨声门癌，选择肿瘤主体以喉室为中心经全喉切除手术的标本５０例，火棉胶包埋，连续切片观察。结果发现①跨声门癌的肿瘤原发部位在喉室，５０例中有Ｔ２３例。②肿瘤以深层浸润为主占９０％（４５／５０），易侵及声门旁间隙（８２％，４１／５０）和甲状软骨（６４％，３２／５０），临床分期与病理分期不符达４８％（２４／５０）。结论：原发喉室的跨声门癌是声门上型癌的一种特殊类型。     

早期声门癌放疗后声音特征的多维评估

早期声门癌放疗后声音特征的评估目前尚缺乏统一的标准、声音是一种多维现象，对其评估应包括对声音质量及声带功能的综合分析，对此学术界已有一定的认同。本文作者选择6O例早期声门癌（TIN。M。）患者作为实验组，ZO例正常人作对照组。对早期串门癌放疗后声音特征的多维评估，以确定引起早期声门癌放疗后声音异常的原因。声音质量评估包括主观感觉评估和客观声学分析；声带功能评估包括喉频闪动态镜图像分析、声音图谱分析、最大发声时间及发声商数测定。实验组6O例患者均仅行放射治疗，分为6个组，每组Ic例，即：纵向组（连续观察组…     

会厌室带癌与声带运动障碍——附50例标本的连续切片观察

对声门上癌中常见的会厌室带癌50例采用火棉胶包埋，整喉连续切片的方法就声带运动障碍这一课题进行了研究。50例中有33例(66．0％)发生声带运动障碍，其原因是癌组织直接或间接对声带、杓状软骨及环杓关节综合作用的结果。尤其声门旁间隙其下部分(喉室外下角水平以下)以及喉室，受癌组织的侵犯是声门上癌发生声带运动障碍的具有特征性的重要原因之一。认为为保证肿瘤切除的彻底性，对有运动障碍的声带，特别是已固定的声带应以切除为宜。     

双蒂带状肌转移修复早期声门癌激光声带切除后声带缺损

治疗早期声门癌在内窥镜下激光声带切除对于局部控制肿瘤、生存和发声功能的保留都有意义，本文阐述了13例早期声门癌患者，全部为男性，年龄42～72岁，平均年龄59岁，术后随访时间3—30个月，平均14个月，激光声带切除术后声带缺损（左侧4例，右侧8例，双侧1例），接受带状肌修复喉成形术。局麻或全麻下在声带切除侧甲状软骨板上方做颈部水平切口，分离带状肌暴露甲状软骨，分离甲状软骨板内侧粘膜，断开甲舌膜和环甲膜，分离胸骨甲状肌和肩胛舌骨肌，在旁开中线5mm处纵行断开甲状软骨板，将肌瓣移位至甲状软骨板内侧与声门旁软组织之间，甲状软骨板断开处对位缝合。     

声带癌前病变及癌变动态喉镜追踪观察

目的 探讨动态喉镜下声带癌前病变的表现及其在癌变追踪中的观察价值。方法 用动态喉镜检测声带癌前病变５２例,观察静态图像及振幅的改变,并追踪观察癌变１～５．５年。结果 声带癌前病变５２例中粘膜波消失或减弱占８６．３％（４５／５２）,振三弱占９．６％（４／５２）,发现癌变（声门癌）Ｔ１１４例,粘膜波消失１００％,振消失或减弱１００％。结论 动态喉镜可用于声带癌前病变与早期声门癌的临别诊断,并作为癌变追     

Partial vertical laryngectomy--indications and surgical technique

Partial vertical laryngectomy is a treatment option for certain T1 glottic cancers. Selection criteria and surgical technique are reviewed. Partial vertical laryngectomy for early vocal cord cancer is considered by some to be an obsolete procedure. However, as outlined in this paper, we believe it is a realistic treatment option for T1 glottic cancers that cannot be removed endoscopically.     

Clinical experience with the treatment of T1b glottic cancer by means of horizontal glottectomy

This study describes the oncological and functional results of horizontal glottectomy performed in a series of 37 similar patients with T1b glottic cancers. The 5-year overall and disease-free survival rates were, respectively, 85.4% and 91.0%. Decannulation was always possible within a mean period of 16.2 days, and no patient developed laryngeal stenosis. A bypass naso-gastric tube was removed a mean 4.9 days after surgery, and adequate swallowing was soon obtained. The mean duration of post-operative hospitalization was 16 days and no major post-operative complications were observed. Satisfactory vocal function was obtained in all cases. On the basis of these results, horizontal glottectomy was found to be a reliable and safe procedure for the management of T1b glottic cancer. Received: 14 January 1999 / Accepted: 1 July 1999     

早期喉癌与声带癌前病变的诊断和微创治疗

目的 对早期喉癌和癌前病变的临床诊断和病理诊断标准及微创伤治疗后的临床效果进行总结和探讨。方法 临床诊断并经病理证实的３２例早期声门癌（Ｔ１ＮｏＭｏ）及２０例癌前病变在显微支撑喉镜下接受粘膜剥脱及声带切除与微波处理微创伤治疗。结果 经３年随访,２６例早期癌术后未见异常,３例复发,２例再次行剥脱术。２０例声带癌前病变分为声带白斑、轻度不典型增生、中度不典型增生、生度不典型增生。手术剥脱后经３年随访无     

早期喉癌与声带癌前病变的诊断和微创治疗

目的　对早期喉癌和癌前病变的临床诊断和病理诊断标准及微创伤治疗后的临床效果进行总结和探讨。方法　临床诊断并经病理证实的 3 2例早期声门癌 (T1N0 M0 )及 2 0例癌前病变在显微支撑喉镜下接受粘膜剥脱及声带切除与微波处理微创伤治疗。结果　经 3年随访 ,2 6例早期癌术后未见异常 ,3例复发 ,2例再次行剥脱术。 2 0例声带癌前病变分为声带白斑、轻度不典型增生、中度不典型增生、重度不典型增生。手术剥脱后经 3年随访无一例转为恶性。结论　①早期喉癌和癌前病变的临床鉴别诊断非常重要 ,常常几种病理形态共存 ,过小的活检组织有漏诊之虞 ,采用剥脱手术 ,即是确切诊断的方法又是有效治疗的措施 ,并能恢复正常发音功能 ;②对于声带活动稍有减弱的声带肿瘤 ,其减弱原因可能与肿瘤重力压迫有关 ,不应放弃粘膜剥脱的微创性治疗 ;③手术后患者的密切随访是至关重要的     

转门肌皮瓣修复T3、T4声门癌扩大部分喉切除术后缺损

过大的喉腔缺损创面修复困难。为保证在根治肿瘤的前提下，恢复喉的发声，呼吸，吞咽防护功能，对６２例晚期（Ｔ３，Ｔ４）声门癌分别行扩大垂直喉切除和次全喉切除术，同期应用双蒂转门肌皮瓣进行喉腔缺损重建。气管套管拔出率为８７．１％，８５％患者发声恢复满意，吞咽功能全部恢复。晚期声门癌选择性地施行功能保全性喉切除术是可行的。手术操作简单，应用广泛，值得推广。     

代偿性声带息肉样变（附12例报告）

分析了12例代偿性声带息肉样变病例,均伴有其它疾病而引起声门闭合下全,其中单侧声带麻痹3例及声带沟9例.病变表现为一侧声带振动部分边缘有半透明水肿状物,呈鱼腹状凸起,其存在有助于改善声门闭合.此外还可见其它喉功能过强的表现如室带肥大及内收超越和健侧声带内收过中线等表现.病史上有起病时声嘶较重,就诊时声嘶程度较前有所改善的特点.本文分析了代偿性声带息肉样变的病史和体征的特点并就其形成的机理、诊断和处理进行讨论.     

Carcinoma of the subglottic area.

The subglottic area is defined as an anatomic region which is cylindrical in shape whose inferior margin is the inferior border of the cricoid cartilage and which is limited superiorly by an imaginary circle 5 mm below the free margin of the true vocal cords. Of 591 patients with glottic and subglottic cancers, only five (percent) had primary subglottic tumors and 132 (22 percent) had glottic tumors with subglottic extension. Sixty-five percent of the patients with glottic primary with subglottic extension were Stage 2 and 35 percent were Stage 3. Most patients were treated surgically. Hemilaryngectomy is a very satisfactory primary modality in the treatment of Stage 2 and some Stage 3 glottic lesions with subglottic extension. Stage 2 and 3 glottic cancers which involve greater than 10 mm of the subglottis carry a significantly decreased prognosis. Patients with T3 lesions with cord fixation with subglottic extension show a decreased survival.     

喉软骨开窗式喉部分切除术治疗T2-3声门型喉癌

目的 探讨喉软骨开窗式喉部分切除术治疗12-3声门型喉癌的手术效果及其价值.方法 2000年10月至2006年12月采用喉软骨开窗式喉部分切除并同时行喉结构及其功能重建术治疗经适当选择的48例T2-3声门型喉癌,其中男29例,女19例;年龄43～78岁,中位年龄57.0岁.在术前及术后6个月作声嘶程度的听觉心理评价,观察双侧声带的活动度、对称性、平静呼吸时声门宽度和发声时声门闭合程度,评价呼吸和吞咽功能情况;随访肿瘤的复发、转移情况以及患者的生存时间.结果 全部患者顺利拔管,切口均甲级愈合,无手术并发症.患者术后6个月时与术前相比,除声带的活动度外(P=0.343),声嘶程度的听觉心理评价(P值均＜0.01)、声带的对称性(P=0.000)、平静呼吸时声门宽度(P=0.001)、发声时声门闭合程度(P=0.001)、呼吸功能(P=0.001)的差异均有显著性统计学意义,术后吞咽功能不受影响(P=0.310).术后喉狭窄1例,复发1例,复发率2.1%;颈淋巴转移1例,肝转移l例;死亡2例.Kaplan-Meier法计算3年和5年生存率分别为96.9%、88.9%.结论 喉软骨开窗式喉部分切除术治疗经适当选择的T2-3声门型喉癌,可有效减小创伤并利于患者的呼吸及发声功能的恢复.     

CO2激光手术治疗声门型喉癌疗效分析

OBJECTIVE: To evaluate the curative effect of CO2 laser in treatment of glottic carcinoma. METHODS: Retrospective analysis of 217 cases of early glottic laryngeal carcinoma treated with laser surgery were carried out. Among these cases, Tis were 22 cases, T1a 108 cases, T1b 38 cases, T2 46 cases, T3 3 cases. 1 case being applied vocal cord excision due to failure of tumor exposure. The follow-up period was 3 to 9 years. RESULTS: Relapse were detected in 21 out of 217 cases of glottic laryngeal carcinoma after CO2 laser surgery under self-retaining laryngoscope. The recurrent rate was 9.7% (21/217). Recurrent ratio of T1a, T1b, T2, T3 were 5.6% (6/108), 21% (8/38), 13.0% (6/46), 1/3 respectively, with significant differences among groups (chi 2 = 6.102, P < 0.01). The recurrent rate was 21.6% of tumors offended the anterior commissure, versus 5.1%(8/157) with no involvement of anterior commissure (chi 2 = 13.64, P < 0.01). 217 cases received laser surgery as the only treatment, 201 cases were still alive. 4 failed to be followed-up(taken into dead number), 12 cases were dead. 3 year survival rate was 97.2%(211/217), 5 year survival rate was 89.4%(118/132). CONCLUSION: It was reliable to use laser surgery in treatment of early glottic laryngeal cancer. The advantages of it included lower complication rate and vocal function was well retained.     

Transoral laser surgery for early glottic cancers

OBJECTIVE: To demonstrate the oncologic safety of transoral endoscopic laser surgery in early glottic cancers. PATIENTS: The study included 107 patients with early glottic cancers. The disease was in situ in 21 (19.6%) and infiltrative in 86 (80.4%), of which 52 (48.6%) were stage T1a, 17 (15.9%) were T1b, 13 (12.1%) were T2, and 4 (3.7%) were TX lesions. One hundred three patients (96.3%) were treated primarily, whereas 4 patients (3.7%) were operated on after radiotherapy failure. Anatomically, 77 lesions (72.0%) involved the anterior or middle third of the vocal cord; 14 lesions (13.1%) involved a single cord and the anterior commissure; 4 "horseshoe" lesions (3.7%) involved both cords and the anterior commissure; 7 lesions (6.5%) involved the posterior third of the cord reaching the vocal process of the arytenoid; and 5 cases (4.7%) involved both cords separately. RESULTS: There were 17 (15.9%) local recurrences (10 among patients with single cord lesions, 5 among patients with cord and anterior commissure lesions, and 2 among patients with lesions involving both cords), and 1 regional recurrence. One hundred one patients (94.4%) were alive and disease free at a median of 40.7 months. Three patients (2.8%) were alive with disease. One patient (0.9%) died of other causes. Two patients (1.9%) died of a second primary cancer. The overall larynx preservation rate was 92.5%. Recurrence-free survival was 86.6% at 2 years, 84.1% at 5 years, and 78.1% at 10 years. CONCLUSION: Transoral laser surgery is an oncologically safe, function-preserving modality for treatment of early glottic cancers.