Myers E N, Alvi A
Department of Otolaryngology, University of Pittsburgh School of Medicine, PA 15213, USA.
Laryngoscope. 1996 May;106(5 Pt 1):559-67. doi: 10.1097/00005537-199605000-00008.
The treatment of cancer of the supraglottic larynx has undergone an evolution. Better understanding of the anatomy and biology of cancer in this anatomic site has enabled surgeons to devise effective oncologic strategies while making every effort to preserve the function of the larynx. Certain recent concepts and changing trends have emerged in the treatment of cancer of the supraglottic larynx, including the treatment of the neck, significance of extracapsular spread of tumor in cervical lymph nodes, and conservation laser surgery. In 1985, Snyderman et al. reported the prognostic significance of extracapsular spread in patients with cancer of the supraglottic larynx. In 1990, Lutz et al. reported the results of our experience with the treatment of 202 patients. The review verified the significant risk of bilateral neck disease in these patients, even with adjuvant radiation therapy. Accordingly, since 1990 all patients having cancer of the supraglottic larynx have been treated in the Department of Otolaryngology at the University of Pittsburgh with bilateral neck dissections. The use of adjuvant radiation therapy has been based on the presence of extracapsular spread. This study documents the oncologic effectiveness of this treatment and confirms the efficacy of bilateral neck dissections in an attempt to control neck disease and the prognostic significance of extracapsular spread. We review the evolution of the treatment of cancer of the supraglottic larynx, present our results, and consider innovative surgical approaches.
声门上型喉癌的治疗方法经历了演变。对该解剖部位癌症的解剖学和生物学有了更深入的了解，使外科医生能够制定有效的肿瘤治疗策略，同时尽一切努力保留喉部功能。声门上型喉癌的治疗出现了一些近期的概念和变化趋势，包括颈部治疗、肿瘤在颈部淋巴结包膜外扩散的意义以及保留性激光手术。1985年，斯奈德曼等人报告了声门上型喉癌患者包膜外扩散的预后意义。1990年，卢茨等人报告了我们治疗202例患者的经验结果。该综述证实了这些患者即使接受辅助放疗也存在双侧颈部病变的显著风险。因此，自1990年以来，匹兹堡大学耳鼻喉科对所有声门上型喉癌患者均进行双侧颈部清扫术。辅助放疗的使用基于包膜外扩散的存在情况。本研究记录了这种治疗方法的肿瘤学有效性，证实了双侧颈部清扫术在控制颈部疾病方面的疗效以及包膜外扩散的预后意义。我们回顾了声门上型喉癌治疗方法的演变，展示了我们的结果，并考虑了创新的手术方法。
