【作者】 徐斌；

【导师】 周水洪；

【作者基本信息】 浙江大学 ， 耳鼻咽喉科学， 2017， 硕士

【摘要】 目的:喉癌、下咽癌是常见的头颈部恶性肿瘤,而手术治疗是喉癌、下咽癌的主要治疗手段,部分晚期病例需结合放化疗等综合治疗。喉癌、下咽癌病人手术首先需原发灶活检病理明确诊断,目前常用的确诊方法有:术前局麻电子纤维喉镜下活检待常规病理确诊、全麻支撑喉镜下活检后待常规病理确诊、以及术中全麻支撑喉镜下原发灶活检术中冰冻切片检查等。而术前局麻电子纤维喉镜下活检可能因患者不能耐受等原因导致组织较少,不能一次确诊导致二次活检;全麻支撑喉镜下活检后待常规病理确诊者,患者必经受二次麻醉;以上两种情况一定程度上增加患者的负担;术中全麻支撑喉镜下原发灶活检术中冰冻切片检查,也可能会出现假阴性或者假阳性,也可能给患者造成一定负担,因此这两种病理确诊方法在喉癌、下咽癌的应用尚有争议。而近年来喉癌、下咽癌手术方式上越来越提倡保留喉功能,而保留尽可能多的正常组织往往会增加切缘阳性的机率,可能影响患者治疗方式的选择、器官功能的保留及预后,因此,如何在完全切除原发灶和尽量保留咽喉功能之间取得一个平衡点是一个优秀手术医生需要仔细衡量的,术中冰冻切片诊断提供了一个肉眼之外判断原发灶和切缘的方法。本研究旨在探讨喉癌、下咽癌术中原发灶及切缘术中冰冻切片诊断的应用价值和可行性。方法:回顾性分析浙江大学附属第一医院2012年1月～2017年9月术前结合喉镜、影像学资料结果考虑为喉部或下咽恶性病变及术前已确诊为喉或下咽鳞状细胞癌者于本院行手术治疗的238例资料,对比分析原发灶及切缘冰冻切片诊断与术后常规病理诊断的符合率。通过门诊复查与电话随访了解复发情况及生存情况。结果:1.行术中活检冰冻切片且最终确诊为喉癌或下咽癌者原发灶冰冻切片诊断与术后常规病理诊断符合率94.6%。2.切缘术中冰冻切片诊断与相应术后常规病理诊断符合率100%。201例喉癌及下咽癌病例中首次切缘冰冻切片阳性者21例,占10.4%。结论:喉癌、下咽癌在术中行原发灶及切缘冰冻切片诊断是确实可行的,指导临床可行一次性手术治疗。更多还原

【Abstract】 Purpose:Laryngeal cancer(LC)and hypopharyngeal cancer(HPC)are common types of head and neck cancer.Main treatment of laryngeal and hypopharyngeal cancers includes surgery,radiotherapy and chemotherapy,etc.Surgery combined with radiotherapy/chemotherapy is especially conducted in advanced patients.A biopsy is required in the primary site of tumor for further evaluation.Fibrolaryngoscopewith local anesthesia and self-retaining laryngoscope with general anesthesia are often used for biopsy,and either routine pathological evaluationor frozen section diagnosis could be carried out in biopsy by self-retaining laryngoscope.Diagnosis is less likely be confirmed by fibrolaryngoscopewithlocal anesthesia at one time due to the difficulty of biopsy procedure,patient intolerance and less amount of specimen,leading to a repeated procedure.Biopsy by self-retaining laryngoscope with general anesthesia and routine pathological evaluation often results in a second time surgery after confirmed pathological diagnosis.Frozen section diagnosis could be done during surgery,but the chance of false positive or negative result reduces its accuracy.Therefore,the choice of bioptic and diagnostic procedure remains controversial.In recent years,preservation of laryngeal function became a prominent subject of surgical treatment of LC and HPC,while more preserved tissue might predicts positive surgical margin,consequently affecting choice of treatment,function preservation and prognosis.So the balance between thorough primary tumorectomy and laryngeal function preservation has to be carefully considered.This study aims to discuss the application value and practicability of frozen section diagnosis of surgical margin during surgery.Methods:A retrospective analysis of pre-surgery laryngostroboscopic images and medical imaging data is carried out on 238 patients who underwent surgery and were diagnosed as LC or HPC in the First Affiliated Hospital Zhejiang University.Coincidence of diagnosis by frozen section biopsy androutine evaluation is analyzed.Relapse or survival of patients are acquired through outpatient medical records and relephone follow-up.Result:1.Coincidence of primary foci diagnosis by frozen section biopsy and routine evaluation is 94.6%in patients with a final confirmed diagnosis as LC or HPC.2.Coincidence of surgical margin diagnosis by frozen section biopsy and routineevaluation is 100%.21 out of 201 LC and HPC provides a positive surgical margin at the first time of biopsy,making up 10.4%of the patients.Conclusion:Diagnosis by frozen section biopsy in primary siteand surgical margin is practical,providing the evidence of possibility of only one surgical treatment.更多还原