喉咽癌内镜检查时显露方法及其对病变侵犯范围的评价  

Displaying of hypopharyngeal carcinoma and its involved ranges with laryngoscopy

作　　者：倪晓光[1] 程荣荣[1] 赖少清[1] 张蕾[1] 贺舜[1] 张月明[1] 王贵齐[1] 

机构地区：[1]中国医学科学院肿瘤医院内镜科,北京100021

出　　处：《中国耳鼻咽喉头颈外科》2012年第3期121-125,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨喉镜检查时喉咽部位的显露方法,提高喉镜对喉咽癌局部侵犯范围判断的准确性。方法 113例喉咽癌患者术前行喉镜检查,喉镜检查时喉咽部的显露采用颈前皮肤牵拉法和吹气球法,观察这两种方法的联合应用对喉咽癌原发病灶和局部侵犯范围的判断情况。结果113例喉咽癌患者中,平静呼吸时仅有33例(29.2%)能够清楚显示喉咽部的具体情况,使用颈前皮肤牵拉法和吹气球法后,有106例(93.8%)能够清楚显示喉咽部的情况,明显优于平静状态下对病变的显露和判断(χ2=99.591,P<0.001)。这两种方法的联合应用对喉咽后壁和环后区是否受侵犯的判断具有明显的优势。结论喉镜检查是喉咽癌术前诊断的一种重要方法,通过使用颈前皮肤牵拉法和吹气球法能够将喉咽后壁和环后区充分分离,使喉咽各壁显露出来,从而明显提高喉咽癌术前分期的准确性。OBJECTIVE The aim of this study was to investigate the strategies of displaying the hypopharynx under laryngoscopy and increasing the accuracy of laryngoscopy in determining the invasion range of hypopharyngeal cancer.METHODS A total of 113 patients with hypopharyngeal cancer were enrolled in this study and underwent laryngoscopy prior to surgery.The hypopharynx was displayed by pulling the anterior cervical skin and using the balloon-blowing maneuver.The primary tumors and regional invasive range of hypopharyngeal cancers were observed with the methods.RESULTS Among 113 patients,the hypopharynx was displayed in only 33 patients（29.2%）using quiet respiration and in 106 patients（93.8%）by pulling the anterior cervical skin and using balloon-blowing maneuvers.A significant difference was noted（χ 2 =99.591,P 〈0.001）.The combined strategy was significantly superior in judging the invasion of the posterior pharyngeal wall and postcricoid area.CONCLUSION Laryngoscopy is important for the diagnosis of hypopharyngeal cancer prior to surgery.Pulling the anterior cervical skin and having the patient blow out using a balloon-blowing maneuver can expose the hypopharyngeal walls and increase the accuracy of the staging of hypopharyngeal cancer before treatment.

关 键 词：下咽肿瘤 喉镜检查 方案评价 肿瘤分期 颈前皮肤牵拉法 吹气球法 

分 类 号：R739.6[医药卫生—肿瘤]