喉癌术后课件

喉癌术后CT表现金晨望1喉癌术后CT表现喉癌概述喉部解剖及ＣＴ表现喉癌不同术式及ＣＴ表现2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3喉癌术后CT表现喉癌概述喉部解剖及ＣＴ表现喉癌不同术式及ＣＴ表现4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5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6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7喉部解剖-支撑结构8喉部解剖-支撑结构9喉部解剖-支撑结构10喉部解剖-支撑结构11喉部解剖-支撑结构12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13喉部解剖－喉腔内皱襞杓状会厌皱襞室带声带14Figure1b.

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18喉部解剖－喉腔分区声门上区声门区声门下区19喉部解剖－会厌间隙20喉癌术后CT表现喉癌概述喉部解剖及ＣＴ表现喉癌不同术式及ＣＴ表现21喉癌不同术式及ＣＴ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22喉癌不同术式及ＣＴ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23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24声带切除术PostsurgicalCTscanattheleveloftheglottisina76-year-oldmanshowsregeneratedmucosaofthevocalcords(*)andotherglotticstructuresthathaveanormalappearance4yearsafteraleftcordectomyand1yearafterarightcordectomy.25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26

Follow-upCTscansobtainedina50-year-oldmanafterafrontolateralpartiallaryngectomyforatumorinvolvingtheleftvocalcordandtheanteriorcommissure.27

Follow-upCTscansobtainedina50-year-oldmanafterafrontolateralpartiallaryngectomyforatumorinvolvingtheleftvocalcordandtheanteriorcommissure.28

Follow-upCTscansobtainedina50-year-oldmanafterafrontolateralpartiallaryngectomyforatumorinvolvingtheleftvocalcordandtheanteriorcommissure.29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30声门上水平半喉切除术PostsurgicalCTscansobtainedina54-year-oldman(a)Axialimageatthelevelofthebaseofthetongueshowstheabsenceoftheepiglottis.(b)Axialimageatthelevelofthehyoidboneshowstheabsenceofpreepiglotticfatandasymmetryoftheneovestibule(white*).Thehyoidbone(arrow)overlapswiththeremainingthyroidcartilage(black*).31Bely-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32Bely-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).33Bely-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).Therighthornisnot34Bely-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)isanchoredtothefirsttwotrachealrings35Bely-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36Bely-TouegNetal.AJNRAmJNeuroradiol2001;22:1872-1880次全喉切除术a57-year-oldmanafteraneartotallaryngectomyforarighttransglottictumorwithsubglotticextension.(a)Axialimageattheleveloftheneoglottis(dynamicphonatoryshunt)showsremnantsoftheleftlaryngealcartilages(partsofthethyroidlaminaandthearytenoidcartilage).(b)Partoftheleftcricoidcartilage(whitearrow)alsoisdepicted.37Bely-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.Atracheostomytubeisclearlyvisibleinthelowerpartoftheneck38Bely-TouegNetal.AJNRAmJNeuroradiol2001;22:1872-1880全喉切除术39全喉切除术Follow-upCTscansina53-year-oldman1yearaftertotallaryngectomy.(a)Axialimageatthesupraglotticlevelshowsadilatedair-filledcavity.(b)Axialimageattheglotticthroughsubglotticlevelsshowstheabsenceofthelaryngealframeworkandsofttiss