Plasmacytoma of the larynx

Amyloid is an extracellular proteinaceous low-molecular-weight fibril. In the larynx, amyloid deposits usually represent a benign localized disease. Although laryngeal amyloidosis is an indolent lesion, amyloid deposition in the larynx may actually result from a lymphoproliferative disorder and not isolated amyloidosis. In this case report, we describe a patient referred for laryngeal amyloidosis who was subsequently diagnosed with extramedullary plasmacytoma of the larynx. The report discusses the presentation, diagnosis, and treatment provided. The importance of systemic workup and accurate tissue diagnosis in differentiating primary amyloidosis and secondary amyloid deposition will be highlighted.     

声带运动不良的喉肌电图特征

目的探讨声带运动不良的喉肌电及诱发肌电变化特征。方法对108例声带活动不良患者临床表现、喉肌电图(自发电位、运动单位电位及募集电位等)及神经诱发电位特征(潜伏期、时程、波幅)进行分析。结果喉返神经麻痹者患侧甲杓肌、环杓后肌可检测到失神经电位如纤颤波和正锐波及再生电位。完全麻痹者肌电为电静息,相应喉内肌诱发电位消失。神经不完全损伤者患侧相应喉肌正常运动单位电位中夹杂失神经电位或再生电位,募集电位为单纯相或混合相,神经诱发电位较弱,其中患侧甲杓肌(2.2±1.0)ms(±s,以下同)、环杓后肌(2.4±1.0)ms 诱发电位平均潜伏期均大于正常受试者(P<0.05);诱发电位波幅离散程度较大,患侧甲杓肌(0.9±0.7)mV、环杓后肌(1.2±1.0)mV 平均诱发电位波幅均明显小于正常受试者(P<0.05)。环杓关节运动障碍者喉肌电正常或稍活跃,神经诱发电位参数与正常无统计学差异。肿瘤侵犯喉肌患者肌电减弱,神经诱发电位潜伏期正常,波幅减小。结论声带活动不良可以通过常规喉肌电图进行初步定性筛查,后经喉神经诱发电位进一步进行半定量分析。     

保留功能的喉癌手术70例报告

目的 :探讨喉部分切除术治疗声门型、声门上型喉癌的远期疗效和功能恢复。方法 :对 1978年 7月～1998年 8月间手术的 70例临床资料进行总结和随访。其中声门型喉癌 6 0例、声门上型喉癌 10例 ;施行喉裂开声带切除术 2 2例 ,垂直半喉切除术 2 2例 ,Majer- Piquet手术 17例 ,水平半喉切除术 7例 ,Arslan手术 2例。结果 :1、3及 5年生存率分别为 98.5 3%、87.0 4%和 78.2 6 %。拔管率为 10 0 %。全部病例恢复经口进食 ,一经拔管均能发音。并发症发生率和术后复发率各为 15 .71%和 13.0 4%。结论 :喉部分切除术是功能保全性喉部恶性肿瘤根治的有效术式。它在切除肿瘤、延长生命的同时可以较好地保留喉的生理功能 ,提高患者术后的生活质量     

纤维喉镜检查对喉次全切除咽环吻合术后新喉口的整复作用

为寻求喉次全切除咽环吻合术后，喉的呼吸、吞咽、发声功能恢复的相关因素，对５７例喉次全切除咽环吻合术后不同时期的患者进行１１５次纤维喉镜检查，经摄像拍照对比观察，发现凡新喉口前后径或左右径为７ｍｍ以上，双侧人工披裂占新喉口后缘约１／５范围，梨状窝形态正常的患者均可顺利拔除气管套管，发音虽沙哑、但清晰响亮可懂度好，且无吞咽困难。过多保留喉粘膜，易形成新喉口活瓣样阻塞造成拔管困难；而保留太少，易致误吸、影响发音。纤维喉镜检查对拔管困难的患者，在新喉口修整术的适应证及手术范围方面有一定指导意义，能提高拔管率、完善喉次全切除术后咽环吻合。     

喉部分切除术173例疗效观察

目的 :探讨喉部分切除术治疗喉癌的疗效。方法 :1 73例喉癌患者均行喉部分切除术 ,其中垂直半喉切除术 4 9例 ,水平半喉切除术 39例 ,额侧切除术 4例 ,保留会厌及甲状软骨板后 1 /3的扩大喉切除术 4 7例 ,喉近全切除术 (Pearson手术 ) 1 7例 ,喉近全切除环舌根吻合术 1 7例。结果 :1 6 8例恢复发音功能 ,1 4 5例 3个月内拔除气管套管。 3、5年生存率分别为 79.77%、6 9.94 % ,局部复发率为 1 8.5 0 %。结论 :进行喉部分切除一定要严格掌握各种术式的适应证 ,正确选择术式。在重建喉时 ,尽量恢复喉的发音、括约保护及呼吸功能     

Current clinical propensity of laryngeal tuberculosis: review of 60 cases

Although laryngeal tuberculosis is not frequent, it still occurs with an increasing incidence of pulmonary tuberculosis. Clinical pattern and spread mechanism of this disease have also changed as well. This study was performed to examine the current propensity seen in laryngeal tuberculosis and the clinical characteristics of this disease in patients showing atypical clinical pattern. The medical and videostroboscopic records of 60 patients with laryngeal tuberculosis diagnosed from the year 1994 to 2004 at the department of otorhinolaryngology in Severance Hospital were analyzed. The age of the patients ranged from 25 to 78 years, with their average age being 49.7 years. The ratio between men and women was 1.9:1. The major symptom encountered was hoarseness (96.6%). Clinically, granulomatous (n=22) and ulcerative types (n=11) of laryngeal tuberculosis were still prevalent, however, the incidence of atypical types such as polypoid (n=16) and nonspecific (n=11) were on the rise. Among the 27 cases that showed polypoid or nonspecific types, unilateral lesion was seen in 20 cases (74%). The most frequently affected area by this disease was true vocal cord, followed by false vocal cord, epiglottis, arytenoids and posterior commissure. Active pulmonary tuberculosis was present in 28 (46.7%), inactive pulmonary tuberculosis in 20 (33.3%), normal lung status in 12 cases (20%). Primary laryngeal tuberculosis was present in 9 cases (15%). Single lesion, polypoid and nonspecific type were prevalent in patients with inactive tuberculosis or normal lungs status. Physicians should be aware of the changes in the clinical pattern of laryngeal tuberculosis, which poses serious complications and risk of spreading.     

保留喉功能的T3期声门上喉癌的手术治疗

目的：探讨T3期声门上喉癌喉功能保留手术的可行性、技术操作和临床疗效。方法：回顾性分析1994～2003年收治的T3期声门上癌70例，均行喉功能保留手术，其中喉声门上水平部分切除术42例，喉声门上水平垂直部分切除术19例，喉环状软骨上部分切除术8例，喉近全切除术1例。以胸骨舌骨肌肌筋膜瓣、颈阔肌肌皮瓣、双蒂接力肌甲状软骨膜瓣、甲状软骨膜瓣等修复喉腔组织缺损，重建喉功能。全部患者均接受术后放疗（剂量50～60Gy）。结果：3年生存率为79．2％，5年生存率为68．4％。70例患者中已拔管60例，拔管率为85．7％。全部患者均恢复经口进食，无明显呛咳及吞咽困难。所有患者均发声成功，无一例因喉腔闭锁而致发声失败。结论：T3期声门上癌虽属晚期喉癌，但只要严格掌握适应证，熟练运用多种修复方法，提高外科手术技巧，保留喉功能是可行的。     

Keys to successful type-1 thyroplasty with Montgomery® implant for unilateral laryngeal immobility in adults

Based on a review of the medical literature, the authors document the key technical points and pitfalls in type I thyroplasty with Montgomery® implant, and the main results and indications in unilateral laryngeal immobility.     

喉全切除环咽吻合喉重建术式的改进

为改进Ａｒｓｌａｎ手术、减轻术后误咽、提高拔管率，总结１９８９年～１９９５年我院行喉全切除环咽吻合喉重建术（Ａｒｓｌａｎ手术）２７例。按ＵＩＣＣ１９８７年标准Ｔ１ｂＮ０８例，Ｔ２Ｎ０１７例，Ｔ３Ｎ０２例。全部病例均为双侧声带病变，病变较轻一侧声带受累在１／２以上。手术要点是：喉全切除只保留会厌和环状软骨，双侧杓状软骨均予切除。常规切除舌骨将环状软骨与舌根及颏下肌肉吻合。术后全部病例保存了发音功能，误咽明显减轻，拔管率为９２．６％（２５／２７）。随访３年以上者１４例，１例死亡，３年生存率９２．８６％（１３／１４）。５年以上者６例，１例失访。５年生存率８３．３３％（５／６）。本术式对减轻误咽提高拔管率有明显效果。     

Pearson术式治疗晚期喉癌28例报告

目的：探讨Pearson术式在治疗晚期喉癌中的作用。方法：采用Pearson术式治疗28例晚期喉癌，对其中的26例同期行颈清扫术或分区性颈清扫术。结果：术后随访3～5年，27例(96．4％)能发声，其中发声良好者11例，一般14例，差2例。无一例误咽。3年生存率为78．6％，5年生存率为68．4％。结论：Pearson术式治疗晚期喉癌，既能保留喉的大部分功能，又能根治病变，提高了一部分传统上需做喉全切除术患者的生活质量。     

Long term follow-up study of laryngeal precancer

The goal of this study was to determine subsequent malignancy on a discrete group of precancerous laryngeal lesions, and to assess the mortality. In a series of 227 patients, average age 51.8 years (ranging from 13 to 80 years). The changes were followed-up for 12.3 years (minimum of 5 years and maximum of 40 years). 58% are living without any sign of premalignant laryngeal mucosal disease, 13% with controlled precancer, and 3% in remission after surgery for carcinoma. 11% died (9% due to cause unrelated to the cancer) and 15% were lost for follow-up. 17% of the group with mucosal hyper- or metaplasia progressed to mild dysplasia, but none progressed to carcinoma. Reinke's oedema recurred in 4%, no malignancy was observed. Carcinoma developed in 16% of laryngeal papilloma (8% in situ and 8% invasive). 15% of mild dysplasia progressed in severity, but none transformed to malignancy. Moderate dysplasia progressed to severe dysplasia in 12%, carcinoma in situ in 4%. Of cases with severe dysplasia 13% developed in situ carcinoma while 43% progressed to invasive cancer. In the whole series progression to severe grade was seen in 7.1%, and malignant transformation in 4.4%. Three patients (1.3%) died due to subsequent carcinoma. Our results agree with some authors; but the majority of them reports higher incidence of malignant transformation. Invasive carcinoma was diagnosed in the follow-up in seven patients. Those represent only 3% of all laryngeal carcinomas diagnosed in our department in the same period of time. Based on the data we have evaluated the intensity of follow-up in patients with hyperplasia, metaplasia, keratosis and mild dysplasia.     

Reinnervation aspects of laryngeal transplantation

Although restoration of laryngeal function after laryngeal transplantation depends on appropriate reinnervation, non-selective reinnervation procedures result in synkinesis and poor function restoration. This study was performed to test the feasibility of selective reinnervation procedures to restore laryngeal function. Three surgical reinnervation procedures were studied each in a group of ten cats: in group 1 a non-selective procedure in which the recurrent laryngeal nerve (RLN) was cut and reanastomosed; in group 2 selective abductor reinnervation was performed with the phrenic nerve; in group 3 selective abductor reinnervation with the phrenic nerve (PN) was combined with selective adductor reinnervation with the ansa cervicalis. Ten weeks after surgical reinnervation abductor and reflex adductor functions were evaluated with videolaryngoscopy and electromyography. Findings demonstrated that non-selective reinnervation not only gave poor abduction during inspiration but even resulted in paradoxical movement during reflex adduction. Selective abductor reinnervation resulted in good abductor function. Selective adductor reinnervation with the ansa cervicalis brought about muscle tonus in the animals studied but no restoration of reflex adduction. Enhanced activity during respiratory distress gave only slight compromise to the abductor function. In all, selective laryngeal reinnervation with the PN and ansa cervicalis produced good restoration of respiratory laryngeal function. However, deglutition following laryngeal motor and sensory reinnervation with protection of the respiratory tract is probably not sufficient, as in the present group of animals no reflex glottic closure was achieved. More research is required. Received: 2 March 1998 / Accepted: 21 April 1998     

Diomed-25半导体激光手术治疗早期声门癌疗效观察

目的：观察激光治疗早期声门癌的临床效果。方法：采用Diomed-25半导体激光器对18例早期声门癌患者进行手术治疗，其中7例在局麻下进行．10例在全麻下进行，1例患者局麻下难以配合，全麻支撑喉镜下前联合暴露困难，遂行喉裂开后以激光切除肿瘤。结果：术后随访3～5年，局部复发3例，其中2例为T1b患者，病变侵犯前联合，1例为T2病变。18例中，失访1例(按死亡计算)，3年生存率为100．0％(18/18)，5年生存率为90．9％(10／11)。除2例肿瘤复发行全喉切除外，余16例均保留了喉发声功能。结论：半导体激光手术治疗早期声门癌，疗效确切，喉功能保留好，并发症发生率低，有临床应用价值。     

喉癌垂直部分喉切除术疗效分析

目的 :评价垂直部分喉切除术治疗喉癌的效果。方法 :1979～ 1990年行手术加放疗 2 4例 ,单纯手术 1例 ;1991～ 1997年行单纯手术治疗 2 2例 ,术后放疗 3例。新声门重建采用甲状软骨外软骨膜修复 2 2例 ,单蒂胸骨舌骨肌修复 14例 ,创面直接对合重建声带 10例 ,游离皮片移植 2例 ,颈前皮瓣修复 1例 ,舌骨肌瓣修复 1例。结果 :拔管率为 98.0 % (47/ 4 8) ,有良好的发声和吞咽功能 ;3、5、10年生存率分别为 89.6 %、82 .9%、6 6 .7% ;局部复发死亡 4例 ,死于远处转移 1例 ,死于食管癌 1例 ,非肿瘤死亡 5例。结论 :垂直部分喉切除术是治疗喉癌的有效术式 ,麻醉方式、手术切除范围和修复方法的合理选择可进一步提高疗效     

Surgical management of type I and II laryngeal cleft in the pediatric population

IntroductionLaryngeal clefts (LC) are congenital malformations of the upper aerodigestive tract that can cause dysphagia, aspiration, and subsequent pulmonary complications. This investigation assessed the outcomes of multidisciplinary evaluation and surgical management of type I and II LC (LC1–2) at a tertiary children's hospital.Materials and methodsA retrospective chart review was used to identify patients who underwent repair of LC1–2 by a single surgeon.ResultsTwenty-five patients who underwent surgical management for LC1–2 were identified. Twenty patients with LC-1 and 5 with LC-2 were included. Most common presentations were aspiration on modified barium swallow (MBS) (76%) and recurrent pulmonary infections (60%). Gastroesophageal reflux disease (GERD) was a concurrent co-morbidity in 68%.Of the 19 patients who presented with preoperative aspiration on MBS, 52.6% had evidence of improvement on their first MBS. This improved to 78.9% at the time of their most recent MBS (10 with resolution of aspiration, 5 with improved tolerance of consistencies). Two patients failed to improve from surgical repair and two had worsened aspiration on most recent MBS.ConclusionEndoscopic repair of laryngeal clefts is a well-tolerated procedure. Concurrent GERD and positive bronchoalveolar lavage (BAL) cultures are common and require management prior to definitive repair. Given the multidimensional nature of swallowing disorders and aspiration, a comprehensive team approach in the evaluation, management, and surveillance of these patients is a valuable complement to surgical repair since not all aspiration may resolve.     

环状软骨上部分喉切除及功能重建术疗效观察

目的探讨环状软骨上部分喉切除及功能重建术的适应证及疗效.方法回顾性研究1997年～2001年期间施行环状软骨上部分切除及功能重建术治疗的17例喉声门癌患者资料. 结果 17例患者均于术后7～16天拔除气管套管,平均11天;术后8～18天拔除鼻饲管,平均15天,拔管率100%.全部病例术后恢复了喉的三大功能.术后3年17例患者均存活,其中5年以上无瘤生存者11例. 结论该术式能在切除癌肿的同时更加有效地恢复喉功能,改善生存质量.     

喉部疾病263例患者的电声门图分析

目的 :探讨电声门图 (EGG)的波形变化对喉部疾病的诊断价值。方法 :采用Dr .speech 3.0软件对12 0例声带息肉、4 2例声带小结、2 1例单侧声带麻痹、4 2例声门型喉癌及 38例Reink’s水肿等 5种喉部疾病患者进行EGG测试 ,对其波形变化进行分析。结果 :不同病变的EGG显示出不同的特殊波形 ,表现出较高的敏感性和特异性。结论 :EGG波形的变化对喉部疾病的诊断提供了客观的量化指标