喉癌侵犯声门旁间隙及甲状软骨的超声解剖基础及临床研究

发布时间：2018-06-25 15:00

本文选题：超声成像 + 超声解剖　；参考：《广西医科大学》2012年硕士论文

【摘要】：目的：通过尸体标本的断层切面与正常人喉部的超声声像对比,建立喉部的超声解剖及声像图的对应关系,在此基础上进行喉癌的超声诊断,并初步探讨喉癌侵犯声门旁间隙及甲状软骨的超声声像表现及其临床应用价值。方法：将4具尸体标本根据喉部解剖标志做不同层厚的断层,典型部位从另外尸体再做补充断面,以完成正常喉部不同解剖标志的断面。40例正常对照者取仰卧位,头略向后仰,颈下加枕,使颈部充分伸直。采用经体表途径,在舌骨水平上缘开始至环状软骨下缘区域扫查。按超声扫查常规,扫查分横、纵、斜切面三种,识别喉部主要解剖组织结构：舌骨、会厌软骨、甲状软骨、环状软骨、室带、声带、喉室等。对87例到耳鼻咽喉-头颈外科就诊的临床怀疑为喉癌的患者,于术前进行喉部超声检查和CT检查。超声检查和CT检查结果与喉镜活检病理诊断或(和)术后病理诊断进行对照分析,获得喉癌的声像图表现。探讨超声检查和CT检查诊断喉癌侵犯声门旁间隙及甲状软骨的敏感性、特异性,并进行有关的统计分析。结果：4具尸体标本按喉部解剖标志共计做断而36份,基本上展示了喉部的重要解剖结构；对40例正常成年人喉部进行超声成像的结果表明,超声成像可清晰显示喉部的正常解剖结构。在87例喉癌可疑病人中,病理证实喉癌74人,其中T1 29、T2 14、T3 15、T4 16例,余原位癌2例,不典型增生5例,炎症6例。74例喉癌患者中,大部分T：,和所有T,患者均行喉全切除术(1例出现远处转移而放弃治疗)。超声判断喉癌侵犯声门旁间隙15例,CT判断喉癌侵犯声门旁间隙14例；超声检查和CT检查对喉癌侵犯声门旁间隙的检出率比较P0.01,表明两种检查在判断喉癌侵犯声门旁间隙的检出率有差异。超声判断喉癌侵犯甲状软骨的符合率为93.3%(14/15),CT超声判断喉癌侵犯甲状软骨的符合率为80%(12/15)；超声检查和CT检查对喉癌侵犯甲状软骨的检出率比较P0.05,表明两种检查在判断喉癌侵犯甲状软骨的检出率有差异,超声检查要优于CT检查。结论：超声成像可比较良好地显示喉部的解剖结构。超声成像可以初步诊断喉癌,显示肿物的部位、大小、形态、数目、内部回声和血供状况等信息。超声成像可作出判断喉癌侵犯声门旁间隙及甲状软骨与否,与CT有一定的差异。超声成像在喉癌分期中具有重要的价值,可为临床制定治疗方案提供重要的依据。
[Abstract]:Objective: to establish the relationship between ultrasonic anatomy and sonogram of larynx by comparing the sectional section of cadaveric specimen with that of normal human larynx, and to diagnose laryngeal carcinoma by ultrasound. The ultrasonographic features and clinical value of laryngeal carcinoma invading the paraventral space and thyroid cartilage were discussed. Methods: four cadavers were divided into four sections with different thickness according to the laryngeal anatomical markers, and the typical parts were used as supplementary sections from other cadavers to complete the supine position of 40 normal subjects with different anatomical markers of normal larynx. Add a pillow under the neck to fully straighten the neck. The hyoid bone was scanned from the upper edge of the hyoid bone to the lower edge of the annular cartilage by the method of body surface. The main anatomical structures of larynx, hyoid bone, epiglottic cartilage, thyroid cartilage, annular cartilage, ventricular band, vocal cord, laryngeal ventricle, etc. Eighty-seven patients with suspected laryngeal carcinoma were examined by ultrasonography and CT before operation. The results of ultrasonography and CT were compared with pathological diagnosis of laryngoscopic biopsy or / and postoperative pathological diagnosis, and the sonographic manifestations of laryngeal carcinoma were obtained. To investigate the sensitivity and specificity of ultrasonography and CT in the diagnosis of laryngeal carcinoma invading the paraventral space and thyroid cartilage. Results A total of 36 specimens of 4 cadavers were amputated according to the anatomic marks of the larynx, which basically showed the important anatomical structure of the larynx, and the ultrasonic imaging of the larynx of 40 normal adults showed that, The normal anatomical structure of the larynx can be clearly demonstrated by ultrasound imaging. Of the 87 suspected laryngeal cancer patients, 74 were confirmed by pathology, including 16 cases of T29 T 214 T 3 15 T 4, 2 cases of residual carcinoma in situ, 5 cases of atypical hyperplasia, 6 cases of inflammation and 74 cases of laryngeal cancer. All patients underwent total laryngectomy (1 patient with distant metastasis and abandoned treatment). 14 cases of laryngeal carcinoma involving paraventral space were evaluated by CT scan. The detection rate of invasive paraventral space of laryngeal carcinoma was compared with that of CT examination (P0.01), which indicated that the detection rate of the two kinds of examination was different in judging the invasive paraventral space of laryngeal carcinoma. The coincidence rate of thyroid cartilage invasion by ultrasound was 93.3% (14 / 15) and the coincidence rate of CT was 80% (12 / 15). The detection rate of laryngeal carcinoma invading thyroid cartilage was compared with that of CT examination (P0.05), which indicated that there was a difference between the two kinds of examination in the diagnosis of laryngeal carcinoma invading thyroid cartilage, and ultrasonic examination was superior to CT examination. Conclusion: ultrasonic imaging can show the anatomic structure of larynx well. Ultrasound imaging can be used to diagnose laryngeal carcinoma, showing the location, size, shape, number, internal echo and blood supply of the tumor. Ultrasonic imaging can be used to judge the invasion of paraventral space and thyroid cartilage in laryngeal carcinoma, which is different from CT. Ultrasound imaging plays an important role in the staging of laryngeal carcinoma and can provide important basis for clinical treatment.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.65

【参考文献】