Sadri Maziar, McMahon Jeremy, Parker Andrew
Head and Neck Centre, Royal Hallamshire Hospital, Sheffield, UK.
Eur Arch Otorhinolaryngol. 2006 Sep;263(9):843-52. doi: 10.1007/s00405-006-0078-y. Epub 2006 Jul 6.
Laryngeal dysplasia is a common clinical concern. Despite major advancements in otolaryngology, a significant number of patients with the condition progress to invasive carcinoma. In the recent years, new diagnostic techniques such as autofluorescence and contact endoscopy have been applied to increase the accuracy of the laryngeal biopsies. Moreover, significant efforts have been made to correlate the histopathological appearance of the dysplastic samples to their clinical course. So far, a wide range of therapeutic strategies for different grades of dysplasia has been suggested by authors; however, there is a lack of outcome reviews. In the current review, the outcome of different therapeutic strategies for severe dysplasia and carcinoma in situ has been compared with statistical analysis. The paper also summarises the current knowledge of the alternative management methods as well as current areas of research in the chemoprevention of the condition. (1) Significant efforts have been made to develop new techniques to improve the accuracy of microlaryngoscopic assessment of laryngeal premalignancy. Comparative studies are required using microlaryngoscopy against the new techniques to evaluate their clinical utility. (2) The meta-analysis suggests a better local control rate with radiotherapy compared to other standard methods of management of dysplasia; however, functional impairment and complications associated with each of the standard treatments should be further evaluated.
喉发育异常是临床上常见的问题。尽管耳鼻咽喉科学取得了重大进展,但仍有相当数量的该疾病患者会发展为浸润性癌。近年来,诸如自体荧光和接触式内镜等新的诊断技术已被应用,以提高喉活检的准确性。此外,人们还做出了巨大努力,将发育异常样本的组织病理学表现与其临床病程联系起来。到目前为止,作者们已经针对不同级别的发育异常提出了广泛的治疗策略;然而,缺乏疗效综述。在本综述中,对重度发育异常和原位癌的不同治疗策略的疗效进行了统计分析比较。本文还总结了替代管理方法的当前知识以及该疾病化学预防方面的当前研究领域。(1)人们已做出巨大努力开发新技术,以提高显微喉镜对喉癌前病变评估的准确性。需要使用显微喉镜与新技术进行比较研究,以评估它们的临床效用。(2)荟萃分析表明,与其他标准的发育异常管理方法相比,放疗具有更好的局部控制率;然而,每种标准治疗相关的功能损害和并发症应进一步评估。