Tian L L, Li L, Zhang J R, Ge J C, Xiao H, Wang C, Zhang B H, Liu M
Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Dec 7;55(12):1137-1142. doi: 10.3760/cma.j.cn115330-20200717-00599.
To evaluate the efficacy of curved suspension laryngoscope assistant transoral surgery (CLATOS) in the examination of hypopharynx, and diagnosis and surgery of early hypopharyngeal carcinoma. Thirty-four patients who underwent detailed examination for lower part of hypopharynx and surgery for early hypopharyngeal carcinoma with CLATOS technique in the Second Affiliated Hospital of Harbin Medical University from January 2019 to January 2020 were analyzed retrospectively. The age ranged from 42 to 74 years old including 28 males and 6 females. Among them, 25 patients complaining of foreign body sensation in the pharynx for more than half a year with a poor exposure of the lower pharynx in the examination with flexible laryngoscope in the outpatient department were admitted to the hospital for the further examination with rigid curved laryngoscopy and 9 patients with stage T1-2 hypopharyngeal squamous cell carcinoma were operated with CLATOS technique. Preoperative, intraoperative and postoperative data were analized. One case of squamous cell carcinoma in esophageal entrance (T1N0M0) and one case of carcinoma in pyriform sinus (T1N0M0) with cervical esophageal carcinoma (T1N0M0) were found in the 25 patients with foreign body sensation in the pharynx. En bloc resection of cancer was obtained in 9 patients with stage T1-2 hypopharyngeal carcinomas and 2 of them underwent tracheotomy. One patient with T1 retrocricoid carcinoma was found to have a carcinoma in situ at the lower part of posterior hypopharyngeal wall in the examination during follow-up, which was resected simultaneously. Postoperatively this patient developed a stenosis in the esophageal entrance, which was dilated twice until swallowing normally. Two patients of T2N0M0 and one of T2N1M0 underwent bilateral neck lymph node dissection just after the removal of primary tumors. During follow-up, none of the 9 patients showed tumor recurrence and complications such as dysphonia and dyspnea. CLATOS technique can provide a promising way in the examination of hypopharynx and the detection of early lesions of hypopharynx and esophageal entrance, and this technique has also the advantages such as full visual angle and easy operation for the resection of early hypopharyngeal carcinoma. The quality of life of patients can be improved while the tumor is removed en bloc with this technique.
评估弯形悬吊喉镜辅助经口手术(CLATOS)在下咽检查以及早期下咽癌诊断和手术中的疗效。回顾性分析2019年1月至2020年1月在哈尔滨医科大学附属第二医院采用CLATOS技术对34例下咽下部进行详细检查及早期下咽癌手术的患者。年龄范围为42至74岁,其中男性28例,女性6例。其中,25例因咽部异物感半年以上且门诊电子喉镜检查下咽暴露不佳而入院,行硬质弯形喉镜进一步检查,9例T1 - 2期下咽鳞状细胞癌患者采用CLATOS技术进行手术。分析术前、术中和术后数据。在25例有咽部异物感的患者中,发现1例食管入口鳞状细胞癌(T1N0M0)、1例梨状窝癌(T1N0M0)合并颈段食管癌(T1N0M0)。9例T1 - 2期下咽癌患者均实现肿瘤整块切除,其中2例行气管切开术。1例T1环状软骨后癌患者在随访检查时发现下咽后壁下部原位癌,同期切除。术后该患者食管入口出现狭窄,经两次扩张后吞咽恢复正常。2例T2N0M0和1例T2N1M0患者在切除原发肿瘤后即刻行双侧颈部淋巴结清扫术。随访期间,9例患者均未出现肿瘤复发及声音嘶哑、呼吸困难等并发症。CLATOS技术在下咽检查及下咽和食管入口早期病变的检测方面提供了一种有前景的方法,该技术在早期下咽癌切除方面还具有视角全面、操作简便等优点。采用该技术切除肿瘤的同时可提高患者的生活质量。