成人喉乳头状瘤恶变17例报告

目的 :探讨成人喉乳头状瘤恶变的临床特征、病理特点及远期治疗效果。方法 :发生恶变的 17例喉乳头状瘤患者中 ,4例 (声门型T3 N1M0 1例 ,声门上型T4N0 M0 1例 ,T4N1M0 2例 )施行了全喉切除术及单侧功能性颈廓清术 ,13例施行了喉裂开及喉部分切除术。术后辅以适当放疗 ,剂量 4 5～ 5 5Gy。 结果 :17例术后 1年内全部拔管 ,拔管率 10 0 %。随访 5年以上 ,4例全喉切除术中 ,1例术后 2年死于肿瘤复发 ,1例于术后 3年 4个月死于肿瘤远处转移 ,2例术后 8年无瘤生存 ,发食管音 ;13例喉裂开及喉部分切除术中 ,随访 3年生存 12例 ,失访 1例 ;5年生存 11例 ,远处转移死亡 1例。结论 :反复活检是术前确诊成人喉乳头状瘤恶变的重要方法 ;彻底的手术切除是治疗的重要手段。

Malignant change of laryngeal papilloma in adults

OBJECTIVE: To explore the canceration of laryngeal papilloma in adults, especially its pathological figures, clinical characters and long-term therapeutic efficacy. METHOD: Among 17 cases of laryngeal papilloma with malignant changes, total laryngectomy and single functional neck dissection were performed for 4 cases (glottis type T3 N1 M0 1, Supraglottic type T4 N0 M0 1, Subglottis type T4 N1 M0 2), partial laryngectomy were performed for other 13 cases. All patients received appropriate radiotherapy whose dose is 45-55 Gy. RESULT: Tracheal cannulas of all patients (17 cases) were pull out one year after operation. The rate of extubation is 100%. All patient were follow-up more than 5 years. Among 4 cases of total laryngectomy, one patient died from tumor recurrence 2 years after operation, one patient died from distant metastasis 3 years and 4 months after operation, two patients still alive without tumor 8 years after operation and voicing by using esophagus. Among 13 cases of partial laryngectomy, 12 patients still alive and 1 patient loss follow-up 3 years after operation; 11 patients still alive and 1 patient died from distant metastasis 5 years after operation. CONCLUSION: It is important that repeatedly biopsies to avoid fail to report the malignant change of laryngeal papilloma. The key to cure is complete resection of tumor.