Maisel R H, Vermeersch H
Ann Otol Rhinol Laryngol. 1981 Sep-Oct;90(5 Pt 1):460-4. doi: 10.1177/000348948109000509.
Four hundred patients with biopsy-proven squamous cell carcinoma of the upper aerodigestive tract were studied for evidence of a synchronous second primary tumor. The protocol of study included in most cases direct laryngoscopy, metal tube bronchoscopy, and esophagoscopy. Chest x-ray studies were performed on all patients and many had barium swallow x-ray studies. Asymptomatic second head and neck primary tumors were found only in the vallecula and esophagus among this series of patients. Metachronous second primary tumors were presented as early as one month after the original endoscopy and were located in areas which had been carefully examined by endoscopy and appeared asymptomatic to the examining physician at the time of the original evaluation. Based on this series of patients, we recommend careful indirect laryngoscopy and oral examination, direct laryngoscopy and esophagoscopy as well as a barium swallow for patients with clinically suspicious mucosal lesion of the upper aerodigestive tract. In view of our failure to discover a single lung carcinoma which was not evident from chest x-ray studies, we recommend bronchoscopy, which adds some morbidity to the endoscopic procedure, not be included unless a specific clinical suspicion is entertained. However, because of the important treatment implication which follow the diagnosis of a new squamous cell carcinoma of the upper aerodigestive tract, we feel it is imperative that the entire esophagus be evaluated in the course of the pretreatment exploration of the patient. Although few esophageal tumors were discovered, their implications in terms of surgical resection and debilitation without much likelihood of long-term patient survival has encouraged us to continue the above described procedure.
对400例经活检证实为上消化道鳞状细胞癌的患者进行研究，以寻找同步性第二原发性肿瘤的证据。研究方案在大多数情况下包括直接喉镜检查、金属管支气管镜检查和食管镜检查。所有患者均进行了胸部X线检查，许多患者还进行了吞咽钡剂X线检查。在这组患者中，无症状的第二头颈部原发性肿瘤仅在会厌谷和食管中发现。异时性第二原发性肿瘤最早在初次内镜检查后1个月出现，位于初次评估时经内镜仔细检查且对检查医生无症状的区域。基于这组患者，我们建议对临床上怀疑有上消化道黏膜病变的患者进行仔细的间接喉镜检查和口腔检查、直接喉镜检查和食管镜检查以及吞咽钡剂检查。鉴于我们未能发现胸部X线检查未显示的任何肺癌，我们建议除非有特定的临床怀疑，否则不包括增加内镜检查发病率的支气管镜检查。然而，由于上消化道新鳞状细胞癌的诊断具有重要的治疗意义，我们认为在患者的预处理探查过程中对整个食管进行评估是必要的。尽管发现的食管肿瘤很少，但它们在手术切除和衰弱方面的影响以及患者长期生存的可能性不大，促使我们继续进行上述检查。
