中・下咽頭表在癌の治療方針―耳鼻咽喉科の立場から

Therapeutic Strategy in Patients with Oropharyngeal or Hypopharyngeal Superficial Cancer from Otolaryngological Point of View

要旨　当院では2002年2月～2009年3月に173例246病変の頭頸部表在癌（声門癌除く）の治療を行った．上部消化管内視鏡を用いたEMRやESD，従来の直達鏡や開口器を用いた2-hand-operation，彎曲型喉頭鏡を用いたELPSなど，種々のアプローチによる治療を実施してきた．これらの治療では出血はもちろん，喉頭浮腫による呼吸困難に注意する必要がある．当院では喉頭浮腫発症が懸念される症例に対しては気管切開ではなく，overnightで気管内挿管管理を行い翌朝抜管している．このような症例を10例経験したが，抜管後に再挿管を必要とした症例はない．また頸部転移を伴う中・下咽頭表在癌例に対しては，まず局所切除を行い，病理学的に頸部リンパ節転移を伴っていても矛盾がないか癌深達度を検討する必要があると考えている．

　246 head and neck superficial cancers in 173 patients have been treated since 2002 in Keiyukai Sapporo Hospital. These lesions were removed by means of endoscopic mucosal resection, endoscopic submucosal dissection, endoscopic laryngo-pharyngo surgery, resection under direct laryngoscopic view and so on. As treatment precautions, we should be cautions about laryngeal edema after resection of superficial carcinomas in oropharynx and/or hypopharynx as well as taking care to control bleeding in the operating field. Patients about whom there was concern regarding laryngeal edema were intubated and underwent ventilation until next morning to prevent difficulty in breathing after post-operative extubation. There were ten patients who needed overnight intubation, but they didn't require to re-intubation. As for superficial head and neck cancer patients with neck lymph node swelling, we think it is important to make sure that the depth of primary cancer in pathology is reasonably sufficient for suspecting neck lymph node involvement.