Misiti A, Macori F, Caimi M, Palmeggiani F, Falchetto Osti M, Iacari V, Anaveri G
Istituto di Radiologia, Università degli Studi di Roma La Sapienza.
Radiol Med. 1997 Dec;94(6):600-6.
The follow-up of the patients submitted to surgery for laryngeal carcinoma requires both clinical and CT examinations, particularly in the cases at high risk of recurrence. Our series consisted of 72 laryngeal carcinoma patients operated on and regularly followed-up with CT to distinguish relapse from normal or abnormal postoperative changes.
Seventy-two laryngeal carcinoma patients were submitted to surgery: total laryngectomy was performed in 33 cases, supraglottic laryngectomy in 16 cases, Labayle subtotal laryngectomy in 18 cases and Mayer Piquet subtotal laryngectomy in 5 cases. The patients were followed-up postoperatively with CT and 94 examinations were performed in all; pathology was performed in all the cases with radiologic suspicion of recurrence (19 patients) and further clinical examinations were performed to exclude recurrence in the 14 cases where imaging findings were questionable.
Local recurrences were confirmed in 16 of 19 patients with positive CT findings. Radiologically, the recurrence appeared as an irregular thickening of the pharyngo-laryngeal wall with inhomogeneous density after i.v. contrast agent infusion. The patients submitted to total or supraglottic laryngectomy recurred most often at the cranial site of resection (5/6 cases), those submitted to Labayle surgery at the mucosa adjacent to the cricoarytenoid unit (3/3 cases) and those submitted to Mayer Piquet surgery in the supraglottic region. Two more patients submitted to emergency tracheotomy recurred at this level. Lymph node recurrences were found in 6 total laryngectomy patients. Misinterpretations were most frequently due to postirradiation changes (5 of 14 cases) or to atypical postoperative images (4/14 cases). Three more patients presented a secondary lesion misinterpreted as a relapse.
Our results confirm the role of CT in the follow-up of the patients operated on for laryngeal carcinoma when CT findings are closely correlated with clinical and endoscopic results, permitting to correctly assess the extent of relapse and possible nodal spread.
对接受喉癌手术的患者进行随访需要临床检查和CT检查，尤其是在复发风险较高的病例中。我们的系列研究包括72例接受手术治疗并定期进行CT随访的喉癌患者，以区分复发与正常或异常的术后变化。
72例喉癌患者接受了手术：33例行全喉切除术，16例行声门上喉切除术，18例行拉贝耶次全喉切除术，5例行梅耶·皮凯次全喉切除术。患者术后接受CT随访，共进行了94次检查；对所有影像学怀疑复发的病例（19例患者）均进行了病理检查，并对14例影像学表现可疑的病例进行了进一步的临床检查以排除复发。
19例CT检查结果阳性的患者中，有16例被证实存在局部复发。在影像学上，复发表现为静脉注射造影剂后咽喉壁不规则增厚，密度不均匀。接受全喉或声门上喉切除术的患者最常于切除部位的头侧复发（5/6例），接受拉贝耶手术的患者于环杓单元相邻黏膜处复发（3/3例），接受梅耶·皮凯手术的患者于声门上区域复发。另外2例接受紧急气管切开术的患者在此水平复发。6例全喉切除术患者发现有淋巴结复发。误判最常见的原因是放疗后改变（14例中的5例）或非典型的术后影像（14例中的4例）。另外3例患者出现了被误判为复发的继发性病变。
我们的结果证实了CT在喉癌手术患者随访中的作用，当CT检查结果与临床和内镜检查结果密切相关时，可正确评估复发范围和可能的淋巴结转移情况。
