Objective: To explore the feasibility and efficacy for the dissection and ligation of the superior laryngeal artery in endoscopic surgery for hypopharyngeal cancer. Methods: Eight cadaveric heads were selected, and the laryngopharynxes were harvested. The positions of the superior laryngeal arteries entering the larynxes were dissected and observed under endoscopic vision, and their anatomical characteristics were summarized. Twenty-nine patients (all were male, aged 39-74 years old) with hypopharyngeal cancer who underwent transoral endoscopic surgery at the Department of Otorhinolaryngology Head and Neck Surgery of the Second Xiangya Hospital, Central South University from January 2018 to December 2019 were selected, and the patients were randomly divided into two groups by drawing lots, namely, the superior laryngeal artery was actively dissected and occluded during surgery in observation group (n=15) or not in control group (n=14). The differences in surgical time, bleeding volume, postoperative complications, and postoperative disease-free survival rate were compared between the two groups. Statistical analysis was conducted using SPSS 25.0 software. Results: The entry point of the superior laryngeal artery into the larynx was approximately at the level of the superior edge of the thyroid cartilage, and entered the larynx at the posterior one-third of the lateral wall of the pyriform fossa. The superior laryngeal artery might be determined through endoscopic exploration in all patients of observation group. The endoscopic surgery time [(40.00±7.56) minutes] and intraoperative bleeding volume [(24.00±8.28) ml] in the observation group were respectively less than those [(48.57±14.06) minutes and (42.86±15.41) ml] in the control group, and the differences were statistically significant (t=-2.064, P=0.049; t=-4.064, P=0.001). There was no case with postoperative bleeding in the observation group, but with one case of postoperative bleeding in the control group. Total disease free survival rate was 86.2% and there was no significant difference in disease free survival rates between the two groups during a follow-up period of at least 36 months (P=0.986). Conclusion: Dissection of the superior laryngeal artery during endoscopic surgery for hypopharyngeal cancer is feasible, and pre-management and occlusion of the superior laryngeal artery can effectively reduce intraoperative bleeding.
目的： 探讨下咽癌经口内镜手术中主动解剖提前凝闭喉上动脉的可行性及对手术的影响。 方法： 选择8个动静脉灌注尸头，将咽喉部离体，在内镜视野下解剖观察喉上动脉入喉位置及走行，总结其解剖特点。选取2018年1月至2019年12月于中南大学湘雅二医院耳鼻咽喉头颈外科接受经口内镜手术的29例下咽癌患者，均为男性，年龄39~74岁。通过抽签将纳入的患者随机分为观察组（15例）和对照组（14例），观察组术中主动解剖凝闭喉上动脉。比较2组患者在手术时间、出血量、术后并发症、术后无瘤生存率上的差异。采用SPSS 25.0软件进行统计学分析。 结果： 在内镜视野下标本的喉上动脉入喉点约在甲状软骨上缘水平，于梨状窝外侧壁的后1/3处入喉。手术中观察组病例均能在内镜下探查定位到喉上动脉。观察组患者内镜手术时间［（40.00±7.56）min］短于对照组［（48.57±14.06）min］，术中出血量［（24.00±8.28）ml］低于对照组［（42.86±15.41）ml］，差异均有统计学意义（t=-2.064，P=0.049；t=-4.064，P=0.001）。观察组术后未发生出血，对照组1例术后出血，2组患者术后均无其他并发症发生。在至少36个月的随访时间中2组无瘤生存率差异无统计学意义（P=0.986），2组总无瘤生存率为86.2%。 结论： 下咽癌经口内镜手术中解剖暴露喉上动脉是可行的，提前处理凝闭喉上动脉可以减少术中出血。.