Saleh E M, Mancuso A A, Stringer S P
Department of Ear, Nose and Throat, Assuit Medical School, Assuit University, Egypt.
Head Neck. 1993 Jan-Feb;15(1):44-52. doi: 10.1002/hed.2880150110.
Ten laryngopharyngectomy specimens were dissected to determine the relative accuracy of computed tomography (CT) and endoscopy under anesthesia for evaluating the inferior extent of pyriform sinus carcinoma. Endoscopic examination failed to detect involvement of the pyriform sinus apex in one patient, and considerably underestimated disease at this level in two others; CT accurately predicted the status of the apex in these three and all other patients. Endoscopy underestimated the inferior extent of tumor in six patients; CT revealed the inferior limit relative to the esophageal verge more accurately in all six of these submucosal extensions. Endoscopy revealed one case of mucosal spread to the esophageal verge not demonstrated by CT. Endoscopy and CT were both correct in revealing the esophageal verge to be involved (one case) and free of disease (two cases). This study also confirmed a common tendency of pyriform fossa cancer to spread through thyrohyoid membrane adjacent to the course of superior laryngeal neurovascular bundle (six cases). High-resolution CT, in experienced hands, is a useful adjunct to endoscopy for detecting submucosal, inferior extension of pyriform sinus carcinoma. This information can influence the choice of the lower margin of resection and method of pharyngeal reconstruction.
解剖了10例喉咽切除术标本，以确定计算机断层扫描（CT）和麻醉下内镜检查在评估梨状窦癌下界方面的相对准确性。内镜检查未能检测出1例患者梨状窦尖部受累，另外2例在该水平对疾病程度有明显低估；CT准确预测了这3例以及所有其他患者的尖部状态。内镜检查低估了6例患者肿瘤的下界；在所有这6例黏膜下扩展病例中，CT更准确地显示了相对于食管边缘的肿瘤下限。内镜检查发现1例黏膜扩散至食管边缘，CT未显示。内镜检查和CT在显示食管边缘受累（1例）和无病变（2例）方面均正确。本研究还证实了梨状窝癌常见的沿喉上神经血管束走行的甲状舌骨膜扩散倾向（6例）。在经验丰富的医生手中，高分辨率CT是内镜检查的有用辅助手段，可用于检测梨状窦癌的黏膜下、下界扩展情况。这些信息可影响切除下缘的选择和咽部重建方法。
