喉癌术后ct表现课件

喉癌术后CT表现 金晨望 喉癌术后CT表现 喉癌概述喉部解剖及 表现喉癌不同术式及 表现 喉癌概述 喉癌占全身恶性肿瘤7 占耳鼻咽喉肿瘤35 病因 抽烟 喝酒 男 女 4 1病理 90 鳞状上皮癌诊断靠喉镜和活检 CT观察深部粘膜下结构和病灶侵润范围 协助术前分期 喉癌术后CT表现 喉癌概述喉部解剖及 表现喉癌不同术式及 表现 喉部解剖 舌骨 喉软骨喉腔内皱襞喉腔分区 起于会厌上缘 至于颈六椎体下缘 喉部解剖 支撑结构 舌骨会厌软骨甲状软骨环状软骨杓状软骨 喉部解剖 支撑结构 舌骨会厌软骨甲状软骨环状软骨杓状软骨 喉部解剖 支撑结构 喉部解剖 支撑结构 喉部解剖 支撑结构 喉部解剖 支撑结构 喉部解剖 支撑结构 喉部解剖 舌骨 喉软骨喉腔内皱襞喉腔分区 起于会厌上缘 至于颈六椎体下缘 喉部解剖 喉腔内皱襞 杓状会厌皱襞室带声带 Figure1b Normallaryngealanatomy Ferreiro Arg ellesCetal Radiographics2008 28 869 882 2008byRadiologicalSocietyofNorthAmerica Ferreiro Arg ellesCetal Radiographics2008 28 869 882 2008byRadiologicalSocietyofNorthAmerica Ferreiro Arg ellesCetal Radiographics2008 28 869 882 2008byRadiologicalSocietyofNorthAmerica 喉部解剖 舌骨 喉软骨喉腔内皱襞喉腔分区 起于会厌上缘 至于颈六椎体下缘 喉部解剖 喉腔分区 声门上区声门区声门下区 喉部解剖 会厌间隙 喉癌术后CT表现 喉癌概述喉部解剖及 表现喉癌不同术式及 表现 喉癌不同术式及 表现 喉部功能 呼吸 吞咽 发音功能 喉功能单位 环杓单位手术目标 最大限度地保护喉的生理功能 喉癌不同术式及 表现 部分切除术声带切除术声门上水平半喉切除术水平半喉切除术环状软骨上部分喉切除术次全喉切除术喉全切除术 声带切除术 适用一侧声带癌 未累及前联合或声带突 声带运动正常者 声带切除术 PostsurgicalCTscanattheleveloftheglottisina76 year oldmanshowsregeneratedmucosaofthevocalcords andotherglotticstructuresthathaveanormalappearance4yearsafteraleftcordectomyand1yearafterarightcordectomy 水平半喉切除术 适用一侧声带癌 累及前联合或声带突 声带运动正常者 Follow upCTscansobtainedina50 year oldmanafterafrontolateralpartiallaryngectomyforatumorinvolvingtheleftvocalcordandtheanteriorcommissure Follow upCTscansobtainedina50 year oldmanafterafrontolateralpartiallaryngectomyforatumorinvolvingtheleftvocalcordandtheanteriorcommissure Follow upCTscansobtainedina50 year oldmanafterafrontolateralpartiallaryngectomyforatumorinvolvingtheleftvocalcordandtheanteriorcommissure 声门上水平半喉切除术 适用一侧声门上癌 侵及一侧喉室 声带及杓状软骨正常者 声门上水平半喉切除术 PostsurgicalCTscansobtainedina54 year oldman a Axialimageatthelevelofthebaseofthetongueshowstheabsenceoftheepiglottis b Axialimageatthelevelofthehyoidboneshowstheabsenceofpreepiglotticfatandasymmetryoftheneovestibule white Thehyoidbone arrow overlapswiththeremainingthyroidcartilage black Bely TouegNetal AJNRAmJNeuroradiol2001 22 1872 1880 环状软骨上部分喉切除术 环舌固定术环舌会厌固定术气管环舌会厌固定术 声门上癌 侵犯喉室 声门 前联合 Bely TouegNetal AJNRAmJNeuroradiol2001 22 1872 1880 环状软骨上部分喉切除术 环舌会厌固定术 AxialCTscansobtainedafterSCPLwithCHEP A Hyoidbone H epiglottis E andneoaryepiglotticfold star B Slightlylowerimageshowsthattheleftarytenoidhasbeenresectedandreplacedbyanexessivesofttissue star Therightarytenoid A isdepicted C Atthelevelofthecricoidcartilage theexcessivesofttissueisvisibleinthesubglotticlumen arrow Aslightlythickenedaspectofthemucosacoveringthecricoidcartilageisdepicted arrowhead Bely TouegNetal AJNRAmJNeuroradiol2001 22 1872 1880 环状软骨上部分喉切除术 环舌固定术 AxialCTscansobtainedafterSCPLwithCHP A Softtissue arrow correspondingtothebaseofthetongueisdepictedbehindthehyoidbone H insteadoftheepiglottisandvalleculae Thepexisprojectsthearytenoids A upperborderofthecricoidcartilage C andhyoidbone H tothesamelevel B Atthelevelofthecricoidcartilage themucosaisthinandregular Theleftinferiorhornofthethyroidcartilagehasbeenspared arrow Therighthornisnot Bely TouegNetal AJNRAmJNeuroradiol2001 22 1872 1880 环状软骨上部分喉切除术 气管环舌会厌固定术 AxialCTscanobtainedafterSCPLwithTCHEP Theanteriorarchofthecricoidcartilagehasbeenresected Therefore theremainingepiglottis arrow isanchoredtothefirsttwotrachealrings Bely TouegNetal AJNRAmJNeuroradiol2001 22 1872 1880 次全喉切除术 声门上癌 侵犯喉室 声门 前联合 环状软骨 Bely TouegNetal AJNRAmJNeuroradiol2001 22 1872 1880 次全喉切除术 a57 year oldmanafteraneartotallaryngectomyforarighttransglottictumorwithsubglotticextension a Axialimageattheleveloftheneoglottis dynamicphonatoryshunt showsremnantsoftheleftlaryngealcartilages partsofthethyroidlaminaandthearytenoidcartilage b Partoftheleftcricoidcartilage whitearrow alsoisdepicted Bely TouegNetal AJNRAmJNeuroradiol2001 22 1872 1880 次全喉切除术 Follow upCTscansobtainedina57 year oldmanafteraneartotallaryngectomyforarighttransglottictumorwithsubglotticextension a Axialimageattheleveloftheneoglottis dynamicphonatoryshunt showsremnantsoftheleftlaryngealcartilages partsofthethyroidlaminaandthearytenoidcartilage b Axialimageataslightlylowerlevelthanashowstheneolarynxasseveralconcentricsoft tissuelayers blackarrow atthemidline Partoftheleftcricoidcartilage whitearrow alsoisdepicted c Axialimageatalowerlevelthanbshowstheabsenceofthethyroidisthmus Atracheostomytubeisclearlyvisibleinthelowerpartoftheneck Follow upCTscansobtainedina57 year oldmanafteraneartotallaryngectomyforarighttransglottictumorwithsubglotticextension a Axialimageattheleveloftheneoglottis dynamicphonatoryshunt showsremnantsoftheleftlaryngealcartilages partsofthethyroidlaminaandthearytenoidcartilage b Axialimageataslightlylowerlevelthanashowstheneolarynxasseveralconcentricsoft tissuelayers blackarrow atthemidline Partoftheleftcricoidcartilage whitearrow alsoisdepicted c Axialimageatalowerlevelthanbshowstheabsenceofthethyroidisthmus Atracheostomytubeisclearlyvisibleinthelowerpartoftheneck Follow upCTscansobtainedina57 year oldmanafteraneartotallaryngectomyforarighttransglottictumorwithsubglotticextension a Axialimageattheleveloftheneoglottis dynamicphonatoryshunt showsremnantsoftheleftlaryngealcartilages partsofthethyroidlaminaandthearytenoidcartilage b Axialimageataslightlylowerlevelthanashowstheneolarynxasseveralconcentricsoft tissuelayers blackarrow atthemidline Partoftheleftcricoidcartilage whitearrow alsoisdepicted c Axialimageatalowerlevelthanbshowstheabsenceofthethyroidisthmus Atracheostomytubeisclearlyvisibleinthelowerpartoftheneck Axialimageatalowerlevelthanbshowstheabsenceofthethyroidisthmus Atracheostomytubeisclearlyvisibleinthelowerpartoftheneck Bely TouegNetal AJNRAmJNeuroradiol2001 22 1872 1880 全喉切除术 全喉切除术 Follow upCTscansina53 year oldman1yearaftertotallaryngectomy a Axialimageatthesupraglotticlevelshowsadilatedair filledcavity b Axialimageattheglotticthroughsubglotticlevelsshowstheabsenceofthelaryngealframeworkandsofttissuesandof