咽、喉及颈段气管原发性小涎腺肿瘤临床病理分析

目的 探讨原发于咽、喉及颈段气管的小涎腺肿瘤的临床病理特点。方法 回顾性分析13例原发于咽、喉及颈段气管的小涎腺性肿瘤。所有病例手术中采用快速冰冻病理切片检查以明确肿瘤的良恶性。2例较大的咽旁间隙多形性腺瘤和2例喉多形性腺瘤采用颈侧切开肿瘤切除术；2例咽肌上皮瘤和2例较小咽旁间隙多形性腺瘤采用口内咽侧切开肿瘤切除术。3例喉腺样囊性癌，1例声门上型T1N0M0患者行水平半喉切除术．2例声门下型喉癌行全喉切除术；2例颈段气管肿瘤患者低位气管切开术加行气管节段切除端端吻合术＋术后放疗。结果13例原发性于咽、喉及颈段气管的小涎腺性肿瘤，男女之比为1：2，良、恶比例为2：1。肿瘤的位置：咽部占50．0％（6／12）、喉部占33．3％（4／12），颈段气管占16．7％（2／12）。良性肿瘤8例．其中多形性腺瘤6例（咽部4例，喉部2例），肌上皮瘤2例（均位于咽部）；病程最短为10天，最长为2月。恶性肿瘤4例．其中腺样囊性癌4例（喉部3例，颈段气管1例），粘液表皮样癌1例（位于颈段气管）。所有患者均行手术治疗，术后均无并发症，痊愈出院。良性肿瘤随访2～12年，失访2例，1例死于其它疾病，余5例无复发。5例恶性肿瘤患者，随访2年～11年，失访1例，余均健在。结论 原发于咽、喉及颈段气管的小涎腺性肿瘤有独特的特点，早期症状不典型或无症状．逐渐增大时才影响所在部位的功能。良性肿瘤被覆的粘膜无破溃，色质无改变．边界清楚，大多呈球形或类球形或分叶状．均不影响神经功能．症状均无突然加重现象。恶性组中均位于喉部及颈段气管，肿瘤表面不光滑，淡红色，边界不清。均可手术治疗。

Clinicopathological study on primary salivary gland tumors of pharynx, larynx and cervical trachea

Objective To investigate the clinicopathologic characters of primary minor salivary gland tumor in the pharynx,larynx and cervical trachea. Methods 13 cases with primary minor salivary gland tumor in the pharynx,larynx and cervical trachea were analyzed retrospectively.The exact diagnosis of the tumors was determined by frozen pathological examination.Two cases of pleomorphic adenoma of the parapharyngeal space and two cases of laryngeal pleomorhic adenoma were removed by transcervical approaches.Two cases of pharyngeal myoepithelioma and two cases of small pleomorhic adenoma in the parapharyngeal space were excised by transoral approaches.A case of supraglottic adenoid cystic carcinoma(T1N0M0) was removed by supraglottic horizontal hemilaryngectomy.Two cases of subglottic adenoid cystic carcinoma were excised by hemilaryngectomy.Two cases of malignant cervical trachea neoplasm were removed with trachea segmental resection and end-to-end anastomosis and postoperative radiotherapy was given. Results The ratio of malignant and benign neoplasm among 13 tumors was 2:1 and male-female ratio was 1:2.The lesion sites were as follows: 6 cases in the pharynx,4 cases in the larynx,2 cases in the cervical trachea.Of 8 cases of benign tumors whose disease course was from 10 days to 2 months,6 cases were pleomorphic adenoma and 2 cases were myoepithelioma.Of 5(4) malignant tumors,4 cases were adenoid cystic carcinoma and one case was mucoepithelioma.All patients were uneventful.After 2~12 years follow-up survey,2 patients of 8 cases with benign tumors lost follow-up survey after operation,one case died of other diseases and the other five cases did no relapse;one patients of 5 cases with malignant tumor lost follow-up survey and other four cases were free from their primary malignant tumors. Conclusion Primary minor salivary gland tumors in the pharynx,larynx and cervical trachea have their special features that early symptoms are not typical or not distinct and local function can be affected when tumors develop gradually.These tumors can be treated by operation.