声门癌的组织病理学研究—附62例连续切片观察

目的:探讨声门癌的发病特点,生长方式及向外扩展特点,声带固定的意义,术式选择与肿瘤复发率生和生存率的关系。方法:62例中,T_1 37例,T_2 9例,T_3 16例。仅1例为T_3N_1M_0,均为喉鳞癌。手术方法:喉全切除术16例,喉垂直部分切除术25例,声带切除术21例,N_1者行同侧颈廓清术。单纯声带切除标本采用石蜡包埋技术,其余采用火棉胶包埋技术,进行连续切片观察。结果:声门癌的生长方式与病理分期有一定关系。临床TNM分期与病理分期不符率为27.4％,估计过低是对喉骨架侵犯估计不足,过高是对肿瘤周围炎性浸润误为肿瘤范围。Reinke's层、弹力圆锥、声门旁间隙、喉室、甲状软骨都有一定的“屏障”作用,前联合受侵应考虑喉骨架可能受侵。术后局部复发率为12.8％,复发时间为3个月～8年,复发病例中以T_2为多。颈淋巴结转移率为4.8％,术后3年生存率98.4％,5年生存率95.2％。结论:声门癌颈部淋巴结转移率低,术后复发率低,生存率高。同侧上下扩展多见,晚期才向对侧扩展。前联合腱是肿瘤向对侧声带、甲状软骨和环状软骨侵犯的通道。声门癌侵及前联合者应考虑喉骨架可能受侵。声带固定不是喉部分切除禁忌证,而是扩大手术范围的指征。

Histopathological study of glottic carcinoma--Result of a step-seriol biopsy sections of larynx in 62 cases

Objective: To explore the characteristic of cancer development, growth partterns and external extension as well as the significance of fixed cord. To reveal the characteristic of the surgical treatments, the recurrence and survival rate in glottic carcinoma. Methods: There were 62 glottic carcinoma patients who were stage T1 in 37, T2 in 9, T3 in 16. Among 62 cases, 16 were total laryngecto-my,25 partial laryngectomy and 21 vocal cordectomy, and all specimens were histopathological studed by series section. Results: The inconsistency rate between clinical T stage and pathology stage was 27. 4% (17/62). Result showed that the overestimation of T stage was 8.1% (5/62) and underestimation of T stage was 19. 4% (12/62). Perhaps the underestimation was caused by the deficient estimate to the invasion to the cartilage of larynx. The overestimation was caused by the wrong estimate peripheral inflammation of the tumor. Reinke's space, elstic cone, paraglottic space, laryngeal ventricle and thyroid cartilage all have some "barrier" function. The cancer cells may invade larynx cartilage if tumors infiltrate into anterior commissure. The local recurrent rate was 12. 9%. The recurrence time was about 3 months to 9 years. The metastasis rate of cervical lymph node was 4. 8%. The survival rate of 3-year and 5-year was 98. 4% and 95. 2% respectively. Conclusion: There is higher survival rate and lower frequency for metastasis of glottic carcinoma if the cancer can be diagnosed and treated at early stage. At early stage, the tumor cells invade toward to the same side of up and low glottis and expanded to controlateral side of glottis at later stage; invasion of tumor cells to controlat-eral side of vocal coed, thyroid cartilage and cricoid cartilage is through of anterior commissure; larynx cartilage may be invaded by the cancer cells if tumors infiltrate into anterior commissure. Fixed cord is not a contraindication for partial laryngectomy and could be surgically removed in a larger area of larynx.