七年制医学课件 耳鼻喉 4喉癌

1. Preface1. Preface (1) The most commonest carcinoma in the larynx(1) The most commonest carcinoma in the larynx (2) The great difference from place to place(2) The great difference from place to place (3) The great difference between male and female(3) The great difference between male and female male: female 10:1 male: female 10:1 (4) The most dangerous age: 5070(4) The most dangerous age: 5070 2. Etiology, unclear (1) smoking (2) drinking (3) air containtment (4) virus infection HPV (5) hormone (6) pre-malignant leisions(癌前病变) papilloma of the larynx(喉乳头状瘤) leukoplakia of the larynx(喉白班病) 正 常 喉 部 Multiple papillomas of the larynx Papillomatosis of the larynx Papilloma of the larynx Papilloma of the larynx and trachea Leukoplakia with dysplasia of the vocal cords Chronic parakeratotic laryngitis 3. Pathology3. Pathology 93%99% 93%99% squamoussquamous cell carcinoma cell carcinoma better differentiated (I-II) better differentiated (I-II) 4. Clinical symptoms and signs4. Clinical symptoms and signs supraglotticsupraglottic carcinoma carcinoma 声门上型癌声门上型癌 glotticglottic carcinoma carcinoma 声门型癌声门型癌 subglotticsubglottic carcinoma carcinoma 声门下型癌声门下型癌 (1) (1) supraglotticsupraglottic carcinoma carcinoma A. early stage: (atypical) A. early stage: (atypical) haemoptysishaemoptysis( (痰中带血痰中带血 ) ) Sore throat Sore throat（喉痛）喉痛） Irritating coughIrritating cough( (刺激性咳嗽刺激性咳嗽 ) ) B. later stage: B. later stage: HoarsnessHoarsness （声嘶）声嘶） DyspneaDyspnea（呼吸困难）呼吸困难） C. easily lymph node C. easily lymph node matastasesmatastases( (淋巴结转移淋巴结转移 ) ) Carcinoma of the epiglottis Advanced squamous cell carcinoma of the larynx (2) (2) glotticglottic carcinoma carcinoma A. early stage A. early stage hoarsness hoarsness B. later stage B. later stage dyspnea dyspnea ( (呼吸困难呼吸困难 ) ) C. difficulty C. difficulty matastasesmatastases (3) (3) sybglotticsybglottic carcinoma carcinoma same as same as supraglottic supraglottic carcinoma carcinoma Carcinoma in situ of the left vocal cord Carcinoma of the anterior glottis Squamous cell carcinoma of the aryepiglottic fold and piriform sinus 5. 5. DiaglosisDiaglosis biopsy biopsy（活检）活检） x-rayx-ray、CT-scanCT-scan、MRIMRI 6. Treatment6. Treatment (1) operation (1) operation ( (手术手术 ) ) partialpartial laryngectomylaryngectomy （部分喉切除术部分喉切除术 ） total total lary