喉癌術(shù)后課件

喉癌術(shù)后CT表現(xiàn)金晨望1喉癌術(shù)后CT表現(xiàn)喉癌概述喉部解剖及ＣＴ表現(xiàn)喉癌不同術(shù)式及ＣＴ表現(xiàn)2喉癌概述喉癌占全身惡性腫瘤7%，占耳鼻咽喉腫瘤35%病因：抽煙、喝酒，男:女=4:1病理：90%鱗狀上皮癌診斷靠喉鏡和活檢，CT觀察深部粘膜下結(jié)構(gòu)和病灶侵潤(rùn)范圍，協(xié)助術(shù)前分期3喉癌術(shù)后CT表現(xiàn)喉癌概述喉部解剖及ＣＴ表現(xiàn)喉癌不同術(shù)式及ＣＴ表現(xiàn)4喉部解剖舌骨、喉軟骨喉腔內(nèi)皺襞喉腔分區(qū)起于會(huì)厭上緣，至于頸六椎體下緣5喉部解剖-支撐結(jié)構(gòu)舌骨會(huì)厭軟骨甲狀軟骨環(huán)狀軟骨杓狀軟骨6喉部解剖-支撐結(jié)構(gòu)舌骨會(huì)厭軟骨甲狀軟骨環(huán)狀軟骨杓狀軟骨7喉部解剖-支撐結(jié)構(gòu)8喉部解剖-支撐結(jié)構(gòu)9喉部解剖-支撐結(jié)構(gòu)10喉部解剖-支撐結(jié)構(gòu)11喉部解剖-支撐結(jié)構(gòu)12喉部解剖舌骨、喉軟骨喉腔內(nèi)皺襞喉腔分區(qū)起于會(huì)厭上緣，至于頸六椎體下緣13喉部解剖－喉腔內(nèi)皺襞杓狀會(huì)厭皺襞室?guī)晭?4Figure1b.

Normallaryngealanatomy.Ferreiro-ArgüellesCetal.Radiographics2008;28:869-882?2008byRadiologicalSocietyofNorthAmerica15Ferreiro-ArgüellesCetal.Radiographics2008;28:869-882?2008byRadiologicalSocietyofNorthAmerica16Ferreiro-ArgüellesCetal.Radiographics2008;28:869-882?2008byRadiologicalSocietyofNorthAmerica17喉部解剖舌骨、喉軟骨喉腔內(nèi)皺襞喉腔分區(qū)起于會(huì)厭上緣，至于頸六椎體下緣18喉部解剖－喉腔分區(qū)聲門(mén)上區(qū)聲門(mén)區(qū)聲門(mén)下區(qū)19喉部解剖－會(huì)厭間隙20喉癌術(shù)后CT表現(xiàn)喉癌概述喉部解剖及ＣＴ表現(xiàn)喉癌不同術(shù)式及ＣＴ表現(xiàn)21喉癌不同術(shù)式及ＣＴ表現(xiàn)喉部功能：呼吸、吞咽、發(fā)音功能、喉功能單位：環(huán)杓單位手術(shù)目標(biāo)：最大限度地保護(hù)喉的生理功能22喉癌不同術(shù)式及ＣＴ表現(xiàn)部分切除術(shù)聲帶切除術(shù)聲門(mén)上水平半喉切除術(shù)水平半喉切除術(shù)環(huán)狀軟骨上部分喉切除術(shù)次全喉切除術(shù)喉全切除術(shù)23聲帶切除術(shù)適用一側(cè)聲帶癌，未累及前聯(lián)合或聲帶突，聲帶運(yùn)動(dòng)正常者24聲帶切除術(shù)PostsurgicalCTscanattheleveloftheglottisina76-year-oldmanshowsregeneratedmucosaofthevocalcords(*)andotherglotticstructuresthathaveanormalappearance4yearsafteraleftcordectomyand1yearafterarightcordectomy.25水平半喉切除術(shù)適用一側(cè)聲帶癌，累及前聯(lián)合或聲帶突，聲帶運(yùn)動(dòng)正常者26

Follow-upCTscansobtainedina50-year-oldmanafterafrontolateralpartiallaryngectomyforatumorinvolvingtheleftvocalcordandtheanteriorcommissure.27

Follow-upCTscansobtainedina50-year-oldmanafterafrontolateralpartiallaryngectomyforatumorinvolvingtheleftvocalcordandtheanteriorcommissure.28

Follow-upCTscansobtainedina50-year-oldmanafterafrontolateralpartiallaryngectomyforatumorinvolvingtheleftvocalcordandtheanteriorcommissure.29聲門(mén)上水平半喉切除術(shù)適用一側(cè)聲門(mén)上癌，侵及一側(cè)喉室，聲帶及杓狀軟骨正常者30聲門(mén)上水平半喉切除術(shù)PostsurgicalCTscansobtainedina54-year-oldman(a)Axialimageatthelevelofthebaseofthetongueshowstheabsenceoftheepiglottis.(b)Axialimageatthelevelofthehyoidboneshowstheabsenceofpreepiglotticfatandasymmetryoftheneovestibule(white*).Thehyoidbone(arrow)overlapswiththeremainingthyroidcartilage(black*).31Bely-TouegNetal.AJNRAmJNeuroradiol2001;22:1872-1880環(huán)狀軟骨上部分喉切除術(shù)環(huán)舌固定術(shù)環(huán)舌會(huì)厭固定術(shù)氣管環(huán)舌會(huì)厭固定術(shù)聲門(mén)上癌，侵犯喉室，聲門(mén)，前聯(lián)合32Bely-TouegNetal.AJNRAmJNeuroradiol2001;22:1872-1880環(huán)狀軟骨上部分喉切除術(shù)－環(huán)舌會(huì)厭固定術(shù)AxialCTscansobtainedafterSCPLwithCHEP.A,Hyoidbone(H),epiglottis(E),andneoaryepiglotticfold(star).B,Slightlylowerimageshowsthattheleftarytenoidhasbeenresectedandreplacedbyanexessivesofttissue(star).Therightarytenoid(A)isdepicted.C,Atthelevelofthecricoidcartilage,theexcessivesofttissueisvisibleinthesubglotticlumen(arrow).Aslightlythickenedaspectofthemucosacoveringthecricoidcartilageisdepicted(arrowhead).33Bely-TouegNetal.AJNRAmJNeuroradiol2001;22:1872-1880環(huán)狀軟骨上部分喉切除術(shù)－環(huán)舌固定術(shù)AxialCTscansobtainedafterSCPLwithCHP.A,Softtissue(arrow)correspondingtothebaseofthetongueisdepictedbehindthehyoidbone(H)insteadoftheepiglottisandvalleculae.Thepexisprojectsthearytenoids(A),upperborderofthecricoidcartilage(C),andhyoidbone(H)tothesamelevel.B,Atthelevelofthecricoidcartilage,themucosaisthinandregular.Theleftinferiorhornofthethyroidcartilagehasbeenspared(arrow).Therighthornisnot34Bely-TouegNetal.AJNRAmJNeuroradiol2001;22:1872-1880環(huán)狀軟骨上部分喉切除術(shù)－氣管環(huán)舌會(huì)厭固定術(shù)AxialCTscanobtainedafterSCPLwithTCHEP.Theanteriorarchofthecricoidcartilagehasbeenresected.Therefore,theremainingepiglottis(arrow)isanchoredtothefirsttwotrachealrings35Bely-TouegNetal.AJNRAmJNeuroradiol2001;22:1872-1880次全喉切除術(shù)聲門(mén)上癌，侵犯喉室，聲門(mén)，前聯(lián)合，環(huán)狀軟骨36Bely-TouegNetal.AJNRAmJNeuroradiol2001;22:1872-1880次全喉切除術(shù)a57-year-oldmanafteraneartotallaryngectomyforarighttransglottictumorwithsubglotticextension.(a)Axialimageattheleveloftheneoglottis(dynamicphonatoryshunt)showsremnantsoftheleftlaryngealcartilages(partsofthethyroidlaminaandthearytenoidcartilage).(b)Partoftheleftcricoidcartilage(whitearrow)alsoisdepicted.37Bely-TouegNetal.AJNRAmJNeuroradiol2001;22:1872-1880次全喉切除術(shù)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.Atracheostomytubeisclearlyvisibleinthelowerpartoftheneck38Bely-TouegNetal.AJNRAmJNeuroradiol2001;22:1872-1880全喉切除術(shù)39全喉切除術(shù)Follow-upCTscansina53-year-oldman1yearaftertotallaryngectomy.(a)Axialimageatthesupraglotticlevelshowsadilatedair-filledcavity.(b)Axialimageattheglotticthroughsubglotticlevelsshowstheabsenceofthelaryngealframeworkandsofttiss