背景:下咽癌因臨床症狀不明顯,患者於就診時往往已是晚期。這一類下咽癌的患者爲確立診斷,傳統需要在全身麻醉下,接受直接喉鏡的切片手術;如此常併有呼吸道阻塞的風險。本研究提出在硬式喉鏡影像監視系統的引導下,於門診局部麻醉,執行晚期下咽癌患者切片之方法與結果。 材料及方法:本研究收集自2003至2007年,於台北醫學大學附設醫院耳鼻喉科門診,臨床上懷疑晚期下咽癌之患者計13名〈均爲男性〉,年齡分布45至72歲,平均57.5歲。於門診局部麻醉,在硬式喉鏡影像錄影系統引導下,以鼻竇內視鏡用彎鉗,執行下咽可疑患處之切片手術。 結果:13名臨床上懷疑晚期下咽癌之患者,除1名因就診時已出現呼吸窘迫現象,安排接受緊急氣管切開手術外,其餘12名臨床上懷疑晚期下咽癌之患者,均於當次門診順利完成切片手術,所採集之病理檢體證實均爲鱗狀上皮癌。 結論:臨床上懷疑晚期下咽癌的患者,經過適當的篩選,以硬式喉鏡影像錄影系統引導,於門診局部麻醉執行切片手術,是簡單安全,且具有效率的方法。
OBJECTIVE: The study goal was to present the technique and results of office-based biopsy of advanced carcinoma in the hypopharynx under video laryngeal telescopic guidance. STUDY DESIGN AND SET: From 2003 to 2007, a total of 13 patients with clinical suspicion of advanced carcinoma in the hypopharynx were studied at the ENT Department of Taipei Medical University Hospital. RESULT: All but one patient were biopsied smoothly with adequate amount of specimens for definite pathologic diagnosis at the time of initial clinical examination. CONCLUSION: In select patients, biopsy of advanced hypopharyneal carcinoma under video laryngeal telescopic guidance can be performed smoothly in an office-based setting. The technique has also proven to be efficient, well tolerated, and with low morbidity. SIGNIFICANCE: Biopsy of advanced hypopharyneal carcinoma with this technique can reduce the use of direct laryngoscope under general anesthesia, which obviates surgery-related morbidity. This technique is both clinically and financially effective.
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