McGuirt W F, Matthews B, Koufman J A
Cancer. 1982 Sep 15;50(6):1195-9. doi: 10.1002/1097-0142(19820915)50:6<1195::aid-cncr2820500629>3.0.co;2-0.
A prospective panendoscopic study (bronchoscopy, laryngoscopy, esophagoscopy) was carried out in 81 consecutively seen, untreated patients newly diagnosed as having a mucosal neoplasm in the upper aerodigestive tract, to determine how many had a synchronous second primary lesion of the aerodigestive tract. Fourteen patients (17%) proved to have multiple primary lesions (14 second-primary and two third-primary lesions). Three lesions were hypopharyngeal, six esophageal, three pulmonary, two laryngeal, and two oropharyngeal. Two of the additional lesions were found during routine head and neck examination, nine lesions would have been found with a single routine symptom- or roentgenogram-directed endoscopic examination; five, because of their location or small size, would not have been found without panendoscopy, even after chest roentgenography, indirect laryngoscopy, and barium esophagography had been done. The most productive endoscopic examinations for detecting second primary lesions were esophagoscopy and laryngoscopy, the former detecting six lesions, the latter five lesions. The yield of chest roentgenograms was low (1/79). No complications resulted from this prospective panendoscopic protocol study. THese findings should reinforce the belief that head and neck cancer is a panmucosal disease of the aerodigestive tract, that silent second synchronous primary lesions are not uncommon, and that every effort should be made to find all primary sites before treatment of the index tumor is begun.
对81例新诊断为上呼吸道消化道黏膜肿瘤且未经治疗的连续就诊患者进行了前瞻性全内镜检查（支气管镜检查、喉镜检查、食管镜检查），以确定有多少患者存在呼吸道消化道同步性第二原发病变。14例患者（17%）被证实有多个原发病变（14个第二原发病变和2个第三原发病变）。3个病变位于下咽，6个位于食管，3个位于肺部，2个位于喉部，2个位于口咽部。其中2个额外病变是在常规头颈检查时发现的，9个病变通过单一常规症状或X线片引导的内镜检查即可发现；5个病变由于其位置或体积较小，即使在进行了胸部X线检查、间接喉镜检查和食管钡餐造影后，若不进行全内镜检查也无法发现。检测第二原发病变最有效的内镜检查是食管镜检查和喉镜检查，前者发现6个病变，后者发现5个病变。胸部X线片的检出率较低（1/79）。这项前瞻性全内镜方案研究未导致任何并发症。这些发现应强化这样一种观念，即头颈癌是呼吸道消化道的全黏膜疾病，无症状的同步性第二原发病变并不罕见，并且在开始治疗索引肿瘤之前应尽一切努力找到所有原发部位。
