25例喉神经内分泌癌的诊治与临床分析  

Diagnosis,Treatment and Clinical Analysis of 25 Cases of Laryngeal Neuroendocrine Carcinoma

作　　者：张洋[1,2] 段翰源[1,2] 李祖飞 郭伟 尹高菲[1,2] 黄俊伟[1,2] 陈晓红 黄志刚[1,2] 钟琦[1,2] Zhang Yang;Duan Hanyuan;Li Zufei;Guo Wei;Yin Gaofei;Huang Junwei;Chen Xiaohong;Huang Zhigang;Zhong Qi(Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Beijing 100730, China;Key Laboratory of Otorhinolaryngology-Head & Neck Surgery Ministry of Education, Capital Medical University,Beijing 100730, China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730 [2]首都医科大学耳鼻咽喉头颈科学教育部重点实验室,北京100730

出　　处：《肿瘤预防与治疗》2019年第7期607-611,共5页Journal of Cancer Control And Treatment

基　　金：国家自然科学基金(编号:XMLX201507);首都卫生发展专项(编号:首发-2018-1-2052);北京市卫生系统高层次人才培养计划(编号:2015-3-022)~~

摘　　要：目的:探讨喉神经内分泌癌的临床特征、病理表现、治疗手段、预后及早期病变支撑喉镜下激光治疗与开放性手术的对比。方法:回顾1995年6月至2018年9月北京同仁医院耳鼻喉头颈外科25例病理证实的原发性喉神经内分泌癌患者的临床病例资料。结果:25例喉神经内分泌癌中,典型类癌4例,不典型类癌13例,小细胞神经内分泌肿瘤6例,大细胞神经内分泌肿瘤1例,复合型神经内分泌癌(小细胞神经内分泌癌+中分化鳞癌) 1例。15人接受支撑喉镜下CO2激光手术治疗,其中1人同时接受支撑喉镜下CO2喉肿物切除术+颈部淋巴节清扫术;7例患者接受半喉切除术,3例患者接受全喉切除术+术后放化疗。随访时间3~102个月,中位随访时间26个月,25例患者的3年和5年总体生存率分别为64%及48%,其中,早期(T1,T2)喉类癌患者支撑喉手术患者的5年生存率(66.7%)略高于开放性手术患者(50.0%),但差异无统计学意义(P>0.05)。结论:喉神经内分泌肿瘤常发生于声门上会厌部位,喉镜下为广基底粗糙肿物,表面不伴有坏死。最终确诊依靠术后综合病理和免疫组化指标。对于早期神经内分泌癌,CO2激光治疗可以取得与开放手术相同的治疗效果,减轻创伤,改善患者的生活质量。Objective: To investigate the clinical features, pathological manifestations, treatment methods, prognosis of laryngeal neuroendocrine carcinoma, and compare laser therapy under laryngoscope and open operations. Methods: From June 1995 to September 2018, 25 cases of neuroendocrine carcinoma originating from larynx confirmed by pathology in otolaryngology, head and neck surgery of Beijing Tongren Hospital were reviewed. Results: Of 25 cases of laryngeal neuroendocrine carcinoma, 4 were typical carcinoid, 13 were atypical carcinoid, 6 were small cell neuroendocrine tumors, 1 was large cell neuroendocrine tumor, and 1 was complex neuroendocrine carcinoma ( small cell neuroendocrine carcinoma and moderately differentiated squamous cell carcinoma). Fifteen patients took CO2 laser surgery under self-retaining laryngoscope ,among which 1 of them received CO2 laryngectomy plus neck lymph node dissection under self-retaining laryngoscope ,7 patients received partial laryngectomy, and 3 received total laryngectomy plus radiotherapy and chemotherapy after operation. The follow-up period was 3-102 months, with a median follow-up period of 26 months. The overall 3-year and 5- year survival rates of 25 patients were 64% and 48%, respectively. There was no significant difference between the 5-year survival rates of early stage (T1 ,T2) patients with open laryngeal surgery (66. 7%) and those of patients with open surgery (50.0%)( P>0.05). Conclusion: Laryngeal neuroendocrine tumors often occur in the supraglottic epiglottis. There is no necrosis on the surface of broad-based rough tumors under laryngeal scope. The final diagnosis depends on comprehensive pathological and immunohistochemical staining after operation. CO2 laser treatment of early neuroendocrine cancer can achieve the same therapeutic effect as open surgery, and improve the life quality of patients.

关 键 词：喉癌 神经内分泌肿瘤 类癌 

分 类 号：R739.65[医药卫生—肿瘤]