摘要
目的:初步总结经口硬质支撑弯喉镜辅助的内镜手术(curved laryngoscope assistant transoral surgery,CLATOS)在下咽部检查及早期下咽癌诊断和治疗的临床应用。方法:回顾性分析哈尔滨医科大学附属第二医院2019年1月至2020年1月应用硬质支撑弯喉镜进行下咽部检查以及应用CLATOS技术手术治疗的34例患者的病例资料,男性28例,女6例,年龄42~74岁。其中,25例为病史超过半年反复就诊的咽异感症患者,且于门诊检查下咽部暴露欠佳,在全麻下行硬质支撑弯喉镜检查;9例为应用CLATOS技术治疗的T1-2期下咽鳞状细胞癌患者。对所有病例术前、术中及术后相关临床资料进行总结分析。结果:在25例咽异感症患者中发现食管入口鳞癌1例(T1N0M0)、梨状窝癌(T1N0M0)伴有颈段食管癌1例(T1N0M0)。9例T1-2期下咽癌患者手术均整块切除,其中2例行气管切开术。1例T1环后癌患者复查时发现原发灶对吻处下咽后壁原位癌,予以切除,术后该患者出现食管入口狭窄,行食管入口扩张术2次后进食正常;2例T2N0M0和1例T2N1M0患者同期行双侧颈淋巴清扫术。9例患者在随访期间(7~15个月)均未出现发音、呼吸困难等并发症,也没有出现肿瘤复发。结论:CLATOS技术有助于发现下咽部及食管入口处肿瘤;该技术在早期下咽癌手术中具有全视角、易操作、损伤小、恢复快等优势,在完整切除肿瘤的同时最大限度保护患者生理功能,提高其生活质量。
Objective To evaluate the efficacy of curved suspension laryngoscope assistant transoral surgery(CLATOS)in the examination of hypopharynx,and diagnosis and surgery of early hypopharyngeal carcinoma.Methods Thirty-four patients who underwent detailed examination for lower part of hypopharynx and surgery for early hypopharyngeal carcinoma with CLATOS technique in the Second Affiliated Hospital of Harbin Medical University from January 2019 to January 2020 were analyzed retrospectively.The age ranged from 42 to 74 years old including 28 males and 6 females.Among them,25 patients complaining of foreign body sensation in the pharynx for more than half a year with a poor exposure of the lower pharynx in the examination with flexible laryngoscope in the outpatient department were admitted to the hospital for the further examination with rigid curved laryngoscopy and 9 patients with stage T1-2 hypopharyngeal squamous cell carcinoma were operated with CLATOS technique.Preoperative,intraoperative and postoperative data were analized.Results One case of squamous cell carcinoma in esophageal entrance(T1N0M0)and one case of carcinoma in pyriform sinus(T1N0M0)with cervical esophageal carcinoma(T1N0M0)were found in the 25 patients with foreign body sensation in the pharynx.En bloc resection of cancer was obtained in 9 patients with stage T1-2 hypopharyngeal carcinomas and 2 of them underwent tracheotomy.One patient with T1 retrocricoid carcinoma was found to have a carcinoma in situ at the lower part of posterior hypopharyngeal wall in the examination during follow-up,which was resected simultaneously.Postoperatively this patient developed a stenosis in the esophageal entrance,which was dilated twice until swallowing normally.Two patients of T2N0M0 and one of T2N1M0 underwent bilateral neck lymph node dissection just after the removal of primary tumors.During follow-up,none of the 9 patients showed tumor recurrence and complications such as dysphonia and dyspnea.Conclusion CLATOS technique can provide a promising way in the exa
作者
田霖丽
李亮
张佳蕊
葛靖春
肖辉
王超
张炳辉
刘鸣
Tian Linli;Li Liang;Zhang Jiarui;Ge Jingchun;Xiao Hui;Wang Chao;Zhang Binghui;Liu Ming(Department of Otorhinolaryngology Head and Neck Surgery,Second Affiliated Hospital of Harbin Medical University,Harbin 150086,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2020年第12期1137-1142,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
喉镜检查
下咽肿瘤
经口手术
器官保留
Laryngoscopy
Hypopharyngeal neoplasms
Transoral surgery
Organ preservation
