喉癌主癌灶手术切缘的临床观察

目的 :探讨喉癌手术的安全切缘 ,为临床治疗提供依据。方法 :对不同原发部位、不同分期、不同方位、不同距离手术切缘的 16 7例喉癌患者作临床评价及病理学观察。结果 :声门区喉癌 2mm、3mm、5mm、10mm切缘其阳性切缘发生率及发生频率差异无显著性 (P >0 .0 5 ) ,声门上区及跨声门型 2mm、3mm与5mm、10mm差异有显著性 (P <0 .0 5 ) ,而 2mm与 3mm、5mm与 10mm差异无显著性 (P >0 .0 5 ) ;晚期患者 (T3 T4 )有淋巴结转移、分化程度低其阳性切缘发生率及发生频率较高 (P <0 .0 5 ) ;前连合、会厌前间隙以及浸润性喉癌深面切缘是易出现阳性切缘的部位。结论 :对声门区喉癌 ,距主癌灶 2mm即可作为安全切线 ,对跨声门癌 5mm可作为安全界限 ,对声门上区安全切缘应在 5mm以外 ,最好达 10mm。术前CT检查、术中准确的临床判断及治疗经验可减少阳性切缘的发生 ;声门区喉癌 ,常规切除前连合 ,声门上区喉癌手术应切除会厌前间隙、会厌谷 ,尤其是甲状软骨上段交角后方组织 ,对跨声门癌切缘深面切至甲状软骨内侧面 ,侵犯甲状软骨膜者则应切除同侧甲状软骨翼板 ,以保持足够的深面切缘

Clinical study of resection margins for the main region of laryngeal carcinoma

Objective:To explore the safe resection margin of laryngeal carcinoma and to provide evidence for clinical treatment. Method: The surgical margins of different original positon, different stage, different derection and different distance were performed with clinical evaluation and pathology observation. Results: For glottic cancer,there was no significant difference for the incidence and the frequency of positive resection margins at 2mm,3mm ,5mm,10mm( P >0.05); For supraglottic and transglottic cancer, there was a significant diffence between 2mm and 5mm,10mm, also was between 3mm and 5mm,10mm( P <0.05), but no difference between 2mm and 3mm,5mm and 10mm; There was a high incidence and frequency of positive resection margins for the patient with advanced stage, lymph nodes metastasis or low differentiation( P <0.05);The common position of positive resection margins was commissural anterior, preepiglottic space and deepness side. Conclusion: For glottic cancer, the resection margins, 2mm far from visible tumor is enough;To transglottic cancer, it should be 5mm; To supraglottic cancer, the safe cutting edge should be 5mm at least, it would be best to reach 10mm . To reduce the positive margins, preoperative examination of CT, the exact clinical judgment during operation and treatment experience is important. For glottic cancer,the commissural anterior shouldbe routinely removed; For supraglottic cancer, the preepiglottic space, vallecula epiglottica, especially to the tissue behind the angle of upper-thyroid cartilage should be resected. For transglottic cancer, the deepness margin should reach the inner side of throid cartilage,if the tumor invasivion reach the perichondrium,the throid cartilage should be resected together.