摘要
目的:本课题拟通过对于SCPL术前及术后颈部的MRI改变,观察SCPL术后MRI喉及颈部解剖的变异,并测量相关参数反映其变化,并分析相关解剖参数与其喉功能恢复的关系,为改良手术操作方法,改善喉功能提供理论数据。
方法:回顾性分析2006年1月至2009年12月38例于广西医科大学第一附属医院耳鼻咽喉头颈外科进行SCPL术患者的临床资料及术前术后MRI资料,其中以术后行MRI随访,且临床资料完整的15例作为研究对象,所有病例均为男性,年龄50-70岁,平均56.25岁。观察SCPL术后喉功能恢复情况测量比较术前及术后MRI有关参数并分析参数变化与喉功能恢复的关系。
结果:①α角、β角、L、E、A、AH、SPH、TPH参数术前后的改变有统计学意义,其测量值能反映杓区厚度、舌骨、会厌、喉体、杓区、环状软骨术前后变化;声门形态改变,声门长轴方向通常呈斜行或不对称,声带缩短、增厚表面光滑,形态呈弧形、三角形、梭形、“T”形和不规则形等。②研究结果表明一些参数如α角、舌骨大脚间距在CHEP术后出现改变,这些变化与其吞咽功能恢复快慢有关系,而且α角其术后大小可由术前大小决定。③气管套管拔管率为100%,CHEP与CHP术式组拔管时间有显著性差异,CHP拔管时间延长。胃管拔管率为100%,CHEP与CHP术式组拔管时间有显著性差异,CHP拔管时间延长。
结论:①术后有统计学意义的参数:α角、β角、L、E、A、AH、SPH、TPH能反映SCPL术后喉部的改变。②与吞咽功能有关的参数:α角、舌骨大脚间距。术后α角>30°吞咽功能恢复快;α角<30°吞咽功能恢复慢,α角<10°的患者易导致术后α角<30°。舌骨大脚间距术后比术前减小的吞咽功能恢复快。③本研究SCPL患者术后喉功能恢复情况较好,与国内外报道相类似。
Objective: The aim of this study for the imaging of MRI changes in the neck before and after SCPL, observed anatomical variation of throat and neck after SCPL, and analysis of relevant anatomical parameters and laryngeal function between surgical procedure for the modified method to improve laryngeal function to provide theoretical data.
Methods: A retrospective analysis from January 2006 to December 2009 at the First Affiliated Hospital of Guangxi Medical University, Otolaryngology Head and Neck Surgery for SCPL for 38 patients with clinical and MRI data before and after operation, in which postoperative MRI follow-up , and 15 cases of complete clinical data for the study, all patients were male, aged 50-70 years, mean 56.25 years. Observe the recovery of laryngeal function after SCPL and compared MRI parameters of measurements and analysis of parameters with laryngeal function recovery. By SPSS16.0 statistical software for statistical analysis of the above.
Results:①α-angle,β-angle, L, E, A, AH, SPH, TPH measurement parameters to reflect the hyoid bone, epiglottis, larynx, arytenoid area, cricoid cartilage, before and after surgery location, thickness spoon area, glottal morphological changes, the long axis of the glottis was usually oblique or asymmetrical vocal cord shortening, thickening and smooth surface curved shape, triangle, spindle, "T"-shaped and irregular.②The results show that the number of parameters such asα-angle, the distance between the two greater cornua of the hyoid bone postoperative change in CHEP, these changes have their swallowing function recovery relations, and theα-angle as the size of its operation by the decision of the preoperative size.③The tracheal tube extubation was 100%, CHEP and CHP surgical extubation time was significantly different, CHP prolonged extubation. Tube decannulation rate was 100%, CHEP and CHP surgical extubation time was significantly different, CHP extubation longer.
Conclusion:①The significant parameters:α-angle,β-angle, L, E, A, AH, SPH, TPH can reflect the change of larynx after Postoperative.②swallowing-related parameters:αangle, distance between the two greater cornua of the hyoid bone. Quick recovery of swallowing function afterα-angle> 30°;αangle <10°after surgery and patients with easily lead angle toα<30°. Quick recovery of swallowing function which the distance between the two greater cornua of the hyoid bone reduces than Preoperative.③SCPL patients in this study the recovery of laryngeal function as better as reports of home and abroad.
引文
[1] Silver CE.Total laryngectomy Surgery for cancer of the lar-ynx and related structures.Philadelphia:W.B.S aunders,1996: 157-182.
[2] Way LW.General surgery in evolution:technologyand competence[J].Am J Surg,1996,171:2-9.
[3] NCCN Practice Guidelines in Oncologyv,2009,Head and Neck Cancer of the Glottic Larynx.
[4]周勇森.喉癌术后复发的影像学诊断.大连医科大学,2007.
[5]李晓兵,陶慕圣.CT及MRI在喉癌诊断中的应用[J].国外医学:耳鼻咽喉分册,1999,23(5):283-286.
[6] Schroder U,Jungehulsing M,Klussmann JP,et a1.Cricohyoidopexy(CHP) and Cricohyoidoepiglottopexy(CHEP).Indication,complic-ations,functional und oncological results[J].HNO,2003,51(1):38-45.
[7] Briggs RJS.CT appearance of the larynx after conservative and radical surgery for carcinomas.J Laryngol Otol,1993,107:565-568.
[8] Majer H,Rieder A.Techinique de laryngectomie permettant de conserver la permeabilite respiratoire:lacricohyoidopexie[J].Ann Otolaryngol Chir Cervicofac,1959,76:377-683.
[9] Labavle J,Dahan S.Reconstructive laryngectomy[J].Ann Otolar-yngol Chir Cervicofac,1981,98:587-592.
[10] Piquet J J,Desaulty A,Decroix G.Cricohyoidoepiglottopexy.Surgical technic and functional results[J].Ann Otolaryngol Chir Cervicofac,1974,91:681-686.
[11] Bron L,Brossard E,Monnier P,et al.Supracricoid partial lar-yngectomy with cricohyoidoepiglottopexy and cricohyoidopexy for glottic and supraglottic carcinomas[J].Laryngoscope,2000,110:627-634.
[12]沈伟.环状软骨上喉部分切除术的探讨[J].中华耳鼻咽喉科杂志,1999,34(6):333-336.
[13] Levine P A,Brasnu D F,Ruparelia A,et al.Management of adva-nced stage laryngeal cancer[J].Otolaryngol Clin North Am, 1997,30:101-112.
[14] Jalisi M,Jalisi S.Advanced laryngeal carcinoma:surgical andnonsurgical management options [J].Otolaryngol Clin North Am,2005,38:47-57.
[15]Bely-Toueg,P.Halimi,O.Laccourreye,F.Laskri,et al.Normal Lar-yngeal CT Findings after Supracricoid Partial Laryngectomy. AJNR,2001,22(11):1872.
[16] C Ferreiro-Argüelles,L Jiménez-Juan,JM,et al.CT findings after laryngectomy.Radiographics.2008 May-Jun,28(3):869-82, quiz 914.
[17] De Vuysere S,Hermans R,Delaere P,et al.CT findings in lary-ngeal chondroradionecrosis.JBR-BTR.1999 Feb,82(1):16-8.
[18] Hermans R,Pameijer FA,Mancuso AA,et al.CT findings in cho-ndroradionecrosis of the larynx.AJNR Am J Neurorad-iol.1998 Apr,19(4):711-8.
[19] Maroldi R.Imaging of postoperative larynx and neck.SeminRoentgenol.2000 Jan,35(1):84-100.
[20] Disantis DJ,Balfe DM,Hayden R,et al.The neck after verticalhemilaryngectomy:computed tomographic study.Radiology.1984 Jun,151(3):683-7.
[21]徐大伟,邓开鸿,卢武胜.喉癌术后的影像诊断学研究.放射学实践, 2004,6(19),451-452.
[22] M Becker et al.Neoplastic invasion of the laryngeal cartil-age:comparison of MR imaging and CT with histopathologic co-rrelation.Radiology,1995,194:661-669.
[23] Williams DW.Imaging of laryngeal cancer.otolaryngol Clin North Am,1997,30:35-58.
[24] Zinreich SJ.Imaging in laryngeal cancer:computed tomograp-hy,magnetic resonance imaging,positron emission tomography[J].Otolaryngol Clin North Am,2002,35(5):971-991.
[25] Kreuzer S,Schima W,Schober E,et a1.Postopertive complicat-ions after larynx resection:assessment with videocinematogr-aphy[J].Radiologe,1998,38(2):109-116.
[26] Antonelli AR,Nicolai P,Luzzago F,et a1.Laringectomia orizz-ontale sopraglottica(LOS)[J].Actaotorhinolaryngeal Ital,1991,33(supp1):27-37.
[27]周梁.喉环状软骨上部分切除术治疗喉声门上型癌[J].中国耳鼻咽喉头颈外科,2005,12(4):205-207.
[28]刘红兵,张少容,罗英,等.环状软骨上喉次全切除术后喉功能探讨[J].中国耳鼻咽喉头颈外科,2006,13(11):737-739。
[29]李彬,樊晋川,王少新,等.21例环状软骨上喉部分切除术临床总结[J].四川医学,2005,26(12):1371-1372.
[30]赵铭,刘善廷,昭忠.环状软骨上喉次全切除术在中晚期喉癌手术中的应用[J].临床耳鼻咽喉科杂志,2006,20(12):561-562.
[31]杨洪,陈乾美,林尚泽.环状软骨上部分喉切除及功能重建术疗效观察[J].中国中西医结合耳鼻咽喉科杂志,2005,13(5):260-261.
[32]杨怀安,郭星,马亮,等.环状软骨上喉部分切除-环舌根会厌吻合术重建喉腔吞咽功能研究[J].中国医科大学学报,2007,36(1):69-70.
[33]柳斌,潘子民,季文樾,等.环状软骨上喉部分切除环舌根会厌吻合术保留一侧杓状软骨手术方法及发声的观察[J].临床耳鼻咽喉科杂志,2005,19(21):961-963.
[34] Bruno E,Napolitano B,Sciuto F,et al.Variations of Neck St-ructures after Supracricoid Partial Laryngectomy:A Multisli-ce Computed Tomography Evaluation.ORL,2007,69:265-270.
[35] Weinstein G S,Laccourreye O,Ruiz C,et a1.Larynxpreservationwith supracricoid partial laryngectomy with cricohyoidoepig-lottopexy.Correlation of videostroboscopic findings and voi-ce parameters.Ann Otol Rhinol Laryngol,2002,111:1-7.
[36]杨怀安,郭星,马亮,等.环状软骨上喉部分切除-环舌根会厌吻合术重建喉腔吞咽功能研究.中国医科大学学报,2007,2(36):69-70.
[1] Silver CE. Total laryngectomy Surgery for cancer of the larynx and related structures. Philadelphia:?. B. Saunders, 1996:15 7-182.
[2] Way LW. General surgery in evolution:technologyand competence [J].Am J Surg, 1996, 171:2-9.
[3] Zinreich SJ. Imaging in laryngeal cancer:computed tomography, magnetic resonance imaging, positron emission tomography[J]. Otolaryngol Clin North Am, 2002, 35(5) :971-991.
[4] Kreuzer S. Postopertive complications after larynx resection: assessment with videocinematography [J]. Radiologe, 1998, 38(2) : 109-116.
[5] Antonelli AR, Nicolai P, Luzzago F, et al. Laringectomia orizz-ontale sopraglottica(LOS)[J]. Actaotorhinolaryngeal Ital,1991, 33(suppl) :27-37.
[6] Majer H, Rieder A,et al.Techinique de laryngectomie permett-ant de conserver la permeabilite respiratoire:lacricohyoido-pexie[J].Ann Otolaryngol Chir Cervicofac, 1959, 76:377-683.
[7] Labavle J, Dahan S.Reconstructive laryngectomy[J]. Ann Otolaryngol Chir Cervicofac, 1981,98:587-592.
[8] Ferlito A,Selver CE,Howard DJ, et al.The role of partial laryngeal resection in current management of laryngeal cancer: a collective review[J]. Acta Otolaryngol,2000, 120:456-465.
[9]剧梁,谢明.喉癌功能保全性手术[J].国际耳鼻咽喉头颈外科杂志,2006,30(1):71-74.
[10] Piquet JJ, Desaulty A, Decroix G..Cricohyoidoepiglottopexy. Surgical technic and functional results[J]. Ann Otolaryngol Chir Cervicofac, 1974,91:681-686.
[11] Laccourreye 0, Ross J, Brasnu D,et al. Extended supracricoid partial laryngectomy with tracheocricohyoidoepiglottopexy[J]. Acta Otolaryngol, 1994, 114:669-674.
[12] NCCN Practice Guidelines in Oncology-v, 2009, Head and Neck Cancer of the Glottic Larynx.
[13]周勇森.喉癌术后复发的影像学诊断.大连医科大学,2007.
[14]李晓兵,陶慕圣.CT及MRI在喉癌诊断中的应用[J].国外医学:耳鼻咽喉分册,1999,23(5):283—286.
[15]潘初,漆剑频.螺旋CT MPR+SSD重建图像在喉部诊断的临床应用[J].放射学实践,2003,18(3):173一176.
[16] M Becker et al. Neoplastic invasion of the laryngeal cartila ge:comparison of MR imaging and CT with histopathologic correlation. Radiology, 1995;194:661-669.
[17] Williams DW.Imaging of laryngeal cancer, otolaryngol Clin North Am, 1997,30:35-58.
[18] Schroder U, Jungehulsing M, Klussmann JP, et al. Cricohyoidope-xy (CHP) and Cricohyoidoepiglottopexy (CHEP). Indication, complications, functionalundoncological results [J]. HN0, 2003, 51(1) :38-45.
[19] Carrat X, Francois JM, Caries D, et al. Laryngomucocele as an unusual late complication of subtotal laryngectomy:case report [J]. Ann Otol Rhinol Laryngol,1998, 107(8):703-707.
[20]屠规益主编.喉癌下咽癌现代理论与临床.济南:山东科学技术出社. 2002:179-209.
[21] Shvero J,Koren R, Zohar L, et al.Laser surgery for the treatm ent of glottic carcinomas[J]. Am J Otolaryngol, 2003, 24(1) :28-33.
[22] Bely Toueg N, Halimi P, Laccourreye 0,et al. Normal laryngeal CT findings after supracricoid partial laryngectomy[J]. AJNR, 2001, 22 (10): 1872-1880.
[23] Soujanen JN et al. Spiral CT of the larynx. Am J Neuroradiol, 1994, 15:1579-1582.
[24] Giron J et al. CT and MR evaluation of laryngeal carcinomas. J Otolaryngol, 1993 Aug, 22(4) :284-93.
[25] Briggs RJS.CT appearance of the larynx after conservative and radical surgery for carcinomas. J Laryngol Otol, 1993, 107: 565-568.
[26] Held P Langnickel R, Breit A et al. CT and MRI in tumors of the hypopharynx and larynx comparison of methods with reference to rapid and ultrafast MR pulse sequences. Laryngorhino-otologie, 1994, 73(2) :59-64.