Dumich P S, Pearson B W, Weiland L H
Arch Otolaryngol. 1984 Oct;110(10):664-9. doi: 10.1001/archotol.1984.00800360036008.
The surgical specimens from total laryngectomy and partial pharyngectomy in 20 consecutive cases of piriform sinus carcinoma were studied by whole-organ serial sectioning in the horizontal plane. There had been gross clinical involvement or fixation of the vocal cord in 19 of these cases. Histopathologic evidence of cartilage invasion or piriform apex involvement was found in 17 specimens. In 13 cases, it appeared, retrospectively, that the cancer could have been adequately encompassed without resecting the entire contralateral side of the larynx. When this element is spared, a sphincteric speaking shunt can be made. Careful preoperative assessment would have correctly predicted the suitability or danger of this approach in 18 of the 20 cases; the two indeterminate cases would have required intraoperative quick section. These findings have meaningful implications regarding the scope of conservation surgery in piriform carcinoma.
对20例梨状窝癌患者行全喉切除术和部分咽切除术的手术标本进行了水平全器官连续切片研究。其中19例临床上有声带明显受累或固定。在17个标本中发现了软骨侵犯或梨状窝尖受累的组织病理学证据。回顾性分析发现，在13例病例中，无需切除整个对侧喉即可充分切除肿瘤。若保留这一结构，则可制作括约肌式发音分流。仔细的术前评估可正确预测该方法在20例病例中的18例是否适用或存在风险；另外2例不确定的病例则需要术中快速切片检查。这些发现对梨状窝癌保喉手术的范围具有重要意义。
