【摘要】 目的 :探讨喉癌手术的安全切缘 ,为临床治疗提供客观依据。方法 :对 16 7例喉癌患者不同原发部位、不同方位、不同距离手术切缘做临床评价、病理学观察及AgNOR各项指标的定量研究。结果 :声门区喉癌AgNOR各项参数 ,肿瘤与 2、5、10mm切缘比较差异均有显著意义 ,P <0 0 5 ;而 2、5、10mm切缘比较差异无显著意义 ,P >0 0 5。声门上区、跨声门型及声门下区喉癌肿瘤与 2mm、5与 10mm对比AgNOR计数差异无显著意义 ,P >0 0 5 ;肿瘤与 5、10mm、2与 5、10mm对比差异有显著意义 ,P <0 0 5。病理观察前连合、会厌前间隙以及浸润性喉癌深面切缘是容易出现阳性切缘的部位。结论 :对以外生性生长为主的声门区喉癌 ,黏膜及黏膜下 2mm切缘即可保证安全 ;以浸润性为主者 2mm黏膜切缘可行 ,但黏膜下切缘需适当加大。对跨声门型、声门上区、声门下区喉癌则至少保证 5mm以外。术前纤维喉镜、CT检查以及选择合适的手术入路可有效减少阳性切缘的发生更多还原

【Abstract】 Objective To explore the safe resected margin of laryngeal carcinoma in order to provide evidence for clinical treatment.Methods The surgical margins of different original positons,different directions and different distances were performed with clinical evaluation,pathology observation and quantitative study of AgNOR.Results For glottic cancer,there was a significant difference for each index of AgNOR between tumor and the resection margins at 2,5,10 mm, P <0 05,yet there was no significant difference between 2, 5,10 mm, P >0 05.For supraglottic,transglottic and infraglottic cancer,there was no significant diffence of AgNOR count between tumor and 2 mm,5 and 10 mm, P >0 05,but there was a significant difference between tumor and 5,10 mm,2 and 5,10 mm, P <0 05.Pathology examination suggested that the common position of positive resection margins was commissural anterior,preepiglottic space and deepness side.Conclusions For glottic cancer,the resection margins,2 mm far from visible tumor is enough for exogenetic vegetation,but for infiltrate vegetation,the resection range should be enlarged.For transglottic and infraglottic cancer,it should be 5 mm.For supraglottic cancer,the safe cutting edge should be 5 mm at least,and it would be the best to reach 10 mm.Preoperative examination of laryngoscope,CT and exact operation access can efficiently decrease the frequency of positive resection margins.更多还原