2010-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/655997摘要：在台灣的頭頸部癌症患者每年有將近6000 名新病例發生。因為煙酒檳榔的關係，其發生率每年以10-20%的成長率逐年增加。頭頸部癌症中的下咽癌常需要在全身麻醉下利用硬式喉頭鏡來取得病理組織，以及評估腫瘤侵犯的範圍。但因牙關緊閉或腫瘤很大實際上常常很困難，甚至有全身麻醉的危險性。下咽癌同時伴隨食道癌比例很高。因此常需要加作困難度且危險性更高的硬式食道鏡或是安排食道攝影或胃鏡另外檢查食道。除此之外，頭頸部癌症患者在治療過後，常併發吞嚥困難，但常因牙關緊閉、咽部狹窄或頸部僵硬等，目前臨床上利用現有的檢查工具不是操作很困難就是靈敏度不夠導致未能有效評估或是排除局部復發以及異時第二新生咽癌或食道癌。近年來，我們開始利用經鼻細徑軟式食道胃鏡在局部麻醉下診斷評估口咽與下咽癌以及食道的檢查。我們也利用此工具來評估頭頸部癌症治療後的吞嚥困難與鑑別診斷。初步結果看來經鼻細徑食道胃鏡在這兩方面的應用上是可行的。再者，我們發現頭頸部癌症同時或異時發生食道癌比例很高。由於食道癌不易早期發現，一但晚期預後極差，因此本硏究中擬在經鼻食道胃鏡檢查的同時收集病患血液，針對目前已知與食道癌的發生有關的基因多型性與環境危險因子以及胃幽門桿菌做分析研究。期能建立頭頸部癌症發生食道癌的預測模型以及追蹤時間表及早發現。這個三年的研究重點以及目的如下:1. 繼續評估經鼻食道胃鏡在口咽與下咽癌的檢查以及頭頸部癌症治療後吞嚥困難的鑑別診斷的應用性，並解決目前遇到的問題。2. 期常規定期追蹤頭頸部癌尤其是下咽癌，以建立適當的追蹤時間表及早發現異時新生食道癌。3. 擴大經鼻食道胃鏡在頭頸部癌症評估上的應用。4. 收集頭頸部癌症患者的血液與相關危險因子的資料，針對目前已知與食道癌的發生有關的基因多型性與環境危險因子以及胃幽門桿菌做分析研究。<br> Abstract: The fresh case number of the primary head and neck cancer is approximately 6000 per yearand the incidence is rapidly increasing along with increasing consumptions of smoking,alcohol drinking and betel nut chewing, with annual increasing rate of 10-20% since ten yearsago in Taiwan. Among them, cancer of hypopharyngeal cancer usually needs rigidlaryngoscopy under general anesthesia to make pathological diagnosis and to evaluate thetumor extent. However, it is frequently difficult and risky because of severe trismus or thehuge local tumor. Besides, esophageal cancer occurs simultaneously in 20-30% of patientswith oro/hypopharyngeal cancers so that another rigid/flexible esophagoscopy oresophagogram is necessary.For post-treatment new-developing dysphagia in patients with primary head and neck cancer,exclusion of local recurrences or second primary cancers is important, but the currentevaluation methods are also usually difficult with low sensitivity to detect small tumorsbecause of severe trismus and narrow pharynx after treatment.Recently, we try to use newly developing trans-nasal ultra-slim esophagogastroscopy todiagnose hypopharyngeal cancers and simultaneously evaluate the esophagus withoutconscious sedation. We also try to use this technique to evaluate new-developing dysphagia inpatients with previous treated head and neck cancers, mainly to exclude newly-growingtumors in the upper digestive tract. The preliminary results of both indications have shownthat these applications are feasible and promising.From our preliminary results, the occurrence of esophageal cancer in patients with primaryhead and neck cancers is really high. Because esophageal cancer is usually diagnosed at latestage with a very poor prognosis in Taiwan, in this study, we plan to collect the demographicdata and the blood samples, which are tested with several known genetic polymorphismsabout esophageal cancer and H. pyloric. From these risk analyses, we try to establish theprediction model for esophageal cancer and to establish follow-up protocol for patients withhead and neck cancers, in order to early diagnose second primary esophageal cancer.So the aims of this three-year study:1. Keeping to evaluate the applications of transnasal esophagogastroscopy in diagnosis ofhypopharyngeal cancers and in differential diagnosis of post-treatment dysphagia withmore cases and to resolve some diagnostic problems we meet now.2. To establish the optimal protocol for following-up patients with hypopharyngeal cancer.3. To elucidate other clinical uses of transnasal esophagogastroscopy in patients withprimary head and neck cancer.4. To establish the prediction model for the occurrence of esophageal cancer in patients withhead and neck cancers via testing and analyses of genetic polymorphisms, environmentalrisk factors and H. pyloric.