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目的:探讨声门癌的发病特点,生长方式及向外扩展特点,声带固定的意义,术式选择与肿瘤复发率生和生存率的关系。方法:62例中,T_1 37例,T_2 9例,T_3 16例。仅1例为T_3N_1M_0,均为喉鳞癌。手术方法:喉全切除术16例,喉垂直部分切除术25例,声带切除术21例,N_1者行同侧颈廓清术。单纯声带切除标本采用石蜡包埋技术,其余采用火棉胶包埋技术,进行连续切片观察。结果:声门癌的生长方式与病理分期有一定关系。临床TNM分期与病理分期不符率为27.4％,估计过低是对喉骨架侵犯估计不足,过高是对肿瘤周围炎性浸润误为肿瘤范围。Reinke’s层、弹力圆锥、声门旁间隙、喉室、甲状软骨都有一定的“屏障”作用,前联合受侵应考虑喉骨架可能受侵。术后局部复发率为12.8％,复发时间为3个月～8年,复发病例中以T_2为多。颈淋巴结转移率为4.8％,术后3年生存率98.4％,5年生存率95.2％。结论:声门癌颈部淋巴结转移率低,术后复发率低,生存率高。同侧上下扩展多见,晚期才向对侧扩展。前联合腱是肿瘤向对侧声带、甲状软骨和环状软骨侵犯的通道。声门癌侵及前联合者应考虑喉骨架可能受侵。声带固定不是喉部分切除禁忌证,而是扩大手术范围的指征。
Objective: To investigate the onset of gliomas, the growth pattern and the characteristics of its outward expansion, the significance of vocal cord fixation, surgical choice and the relationship between tumor recurrence rate and survival rate. Methods: Of the 62 cases, T_1 was 37, T_2 was 9, and T_3 was 16. Only 1 case of T_3N_1M_0, are laryngeal squamous cell carcinoma. Surgical methods: total laryngectomy in 16 cases, 25 cases of partial laryngectomy, 21 cases of vocal cord resection, N_1 line ipsilateral neck clearance surgery. Simple vocal cord resection specimens using paraffin embedding technology, the other using collodion embedded technology for continuous section observation. Results: The growth of gliomas is related to the pathological stage. Clinical TNM staging and pathological staging incompatible rate was 27.4%, underestimation of the estimate of the laryngeal skeleton invasion is underestimated, too much is the tumor around the inflammatory infiltration mistaken for the tumor range. Reinke’s layer, elastic cone, paraglottic gap, throat chamber, thyroid cartilage have a certain “barrier” effect, the former joint invasion should consider the laryngeal skeleton may be affected. Postoperative local recurrence rate was 12.8%, the recurrence time was 3 months to 8 years, the recurrence of cases to more T_2. The rate of cervical lymph node metastasis was 4.8%, the 3-year survival rate was 98.4% and the 5-year survival rate was 95.2%. Conclusion: The glioma has a low rate of cervical lymph node metastasis, low recurrence rate and high survival rate. More common on the ipsilateral expansion, late expansion to the opposite side. Anterolateral tendon is the tumor invasion of the contralateral vocal cord, thyroid cartilage and annular cartilage invasion. Glottic cancer invading the anterior joint should consider the possibility of invasion of the laryngeal skeleton. Vocal cord fixation is not a contraindication for laryngectomy, but rather an indication of an expanded surgical range.