摘要
背景:喉癌术后潜伏着复发的危险,因此,如何及时或早期发现肿瘤复发是非常重要的。对于喉癌术后的患者,在随诊过程中,定期联合应用间接喉镜和纤维喉镜检查,能够识别大多数局限于粘膜表面复发的肿瘤。而影像学检查尤其是CT对发现喉癌术后患者的局部复发起着关键作用,它主要用于观察复发的肿瘤侵及喉粘膜下及深层组织的程度。影像学检查可以显示复发肿瘤的位置、范围及与周围血管、神经的关系,对临床上进一步的治疗具有重要的指导作用。特别是增强CT对喉癌术后的局部复发、淋巴结转移、甚至远处转移均能提供十分明确的诊断依据。喉癌手术后,正常的解剖影像标志发生了一定程度的改变,为了辨认这种改变,判断是否有肿瘤复发、以及恰当地估计复发肿瘤累及的范围,我们应该熟练掌握其术后影像结构特点及复发肿瘤的影像特征。因此,本文分几种经典喉切除术式来综述喉癌术后的组织结构改变以及肿瘤复发的影像学特点,供耳鼻喉科临床医师在喉癌术后复发的诊断和治疗上参考。
目的:分析喉癌术后复发患者的影像学(主要是CT方面)表现,进而为喉癌术后复发的临床再治疗方式提供依据。
方法回顾性分析了中国医学科学院肿瘤医院头颈外科及本科的喉癌术后复发的33例患者的影像学表现,复发部位包括局部复发、淋巴结转移、远处转移三个方面,均有病理证实为肿瘤复发。
结果:声门型喉癌复发21例,声门上型喉癌复发11例,声门下型喉癌1例.局部复发12例,淋巴结转移10例,局部复发并淋巴结转移10例,局部复发、淋巴结转移及远处肺转移一例。在复发性的喉肿瘤中,MSCT多显示形态不规则或欠规则的肿块或结节状,密度不均且不均匀增强,肿块大者可见其中心区不规则形低密度坏死区,其周围结构常受压、受侵。CT增强扫描后往往能勾划出复发灶的边缘。而对于复发性喉癌合并的已清扫的淋巴结床复发或新出现的淋巴结转移来说,CT检查也显示出它的优势,因为CT增强扫描图像能准确地判断出局部淋巴结有无肿大。在发现的21例转移淋巴结中,16例转移淋巴结表现是颈内静脉淋巴结的直径大于10mm或15mm,5例为增强CT扫描见淋巴结边缘强化,中心有低密度或坏死区。远处转移为双肺转移一例。
结论:喉癌患者术后影像定期随访很重要,增强CT是评价喉癌术后患者有无复发必要的检查方法,对评价颈部复发的准确性明显优于临床触诊。做为耳鼻喉科医师应该了解各种喉手术后的残喉组织结构特点及术后复发的影像学特征,在随访中,早期发现,早期治疗,对于复发率高的喉癌患者更是如此。喉癌术后复发的患者在影像上常有特定表现,掌握好其特点,可有针对性的对患者进行有效的治疗,以达到更好的治疗效果,延长患者生命,提高生存质量。
Background: The post-operated patients of laryngeal carcinomas have potential dangers of recurrence. Therefore,it is important how to discovery the recurrent tumour promptly and early. During the following-up of patients after partial and total laryngectomies, it may be found the recurrent tumour local on surface of membrana mucosa combining indirect laryngoscope with laryngofiberscopy. However, as a result, recurrent disease or residual neoplastic tissue often difficult to be detected particularly when there is a submucosal spread. The imaging, especially enhancement CT assumes a role in recurrent disease on the detection of submucosal lesions,which can display the location、boundary and relationship with peripheral vessels and nerve . So it may guide the postoperative clinical treatment. Enhancement CT exami- nation can offer full of diagnositic evidence of regional recurrence、neck recurrence even distant metastasis. The normal imaging of anatomy identifications will occur some extent of modifies after laryngectomies,so we understanding the normal postoperative patterns after conservative and radical surgery is essential to differentiate posttreatment changes from recurrences and to assess the submucosal extent of recurrent disease. Furthermore, the knowledge of particular variations of the surgical procedure is effective for the proper evaluation of postoperative findings in many cases. For this reason,this article summarize the imaging changes in several typical postoperative alterations and recurrent tumour,which expected to offer a few references to E.N.T doctors in diagnose and treatment .
Objective : The purpose of this study was to analyze the imaging appearance(major in CT) of the recurring laryngeal carcinoma with surgical treatment,and then expected to guide the postoperative clinical treatment of laryngeal carcinoma patients。
Method: The imaging features in 33 patients (major in CT) of the recurring laryngeal carcinoma after partial and total laryngectomies ,which obtained from the Department of Head and Neck Surgery Cancer Hospital (Institute), Chinese Academyof Medical Sciences and the Department of E.N.T Affiliated First Hospital DL Medical University from 2005 to 2006.the recurrent tumour consist of regional recurrence、neck recurrence and distant metastasis , confirmed by laryngoscopy , biopsy or surgery , were retrospectively analyzed.
Result:of the 33 recurrent tumour, primarily squamous cell carcinoma (SCC) of the larynx ,glottic carcinoma(n=21), supraglottic carcinoma(n=11), hypolarynx carcinoma(n=1), regional recurrence (n=10),neck recurrence(n=10) regional and nodal recurrence (n=10),distant metastasis(n=1)。The dierffent postoperative imaging appearances were carefully analyzed among them.Within the recurrent tumour, enhancement CT shows recurrent tumour soft tissue mass、thickening,the center may have irregular low density zone of necrosis,its peripheral structure often compressed or invaded. CT can define the borderline of mass.of the neck recurrence, it can judge the nodal increment or not exactly.In the total 21 regions of cervical lymph node had nodal metastases ,of which ,16 regions can be diagnosed by CT when diameter≥10mm or 15mm as size criterion is used.Enhanceing rim ,central necrosis are reliable signs as diagnosing criterion is used ,too.Of the 33 ,one case occurs pulmonary metastasis confired by pathology.
Conclusion :Period imaging following-up is important to the postoperative patients of Laryngeal Carcinomas . Enhancement CT is the basic imaging modality to assess those patients recur or not .The accuracy of CT is superior to phsicial palpation in evaluation cervical lymph node metastases.Otorhinolaryngologist should know not only the CT manifestation of the normal partial and total laryngectomies but also the recurrent tumour. Only that can we early discovery and treatment , especially to those easy recur cases . It is more possible to develop individual treatment, approach better prognosis, give prolongation of life, improve living quality.
引文
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