不同术式治疗喉恶性肿瘤的效果及并发症分析

Effect and complications of different surgical methods in treatment of laryngeal carcinoma

目的对比研究二氧化碳激光喉切除术和开放式部分喉切除术治疗喉恶性肿瘤的效果,及其并发症发生情况。方法收集2013年1月至2018年1月于上海交通大学医学院附属仁济医院就诊的101例Ⅰ~Ⅲ期喉鳞状细胞癌患者临床资料,根据手术方式的不同分为开放组和微创组。开放组(57例)采用开放式部分喉切除治疗,微创组(44例)采用二氧化碳激光喉切除治疗。通过电话、门诊复诊等方式进行回访,按照不同临床分期(Ⅰ期、Ⅱ期、Ⅲ期)及肿瘤发生部位(声门型、非声门型)分别对2组患者的手术时间、术后喉黏膜水肿时间、术后住院时间、5年生存率、并发症发生率、复发率进行比较。结果微创组患者手术时间、术后喉黏膜水肿时间、术后住院时间均短于开放组(均P<0.05)。2组之间相同临床分期、声门型患者的5年生存率比较,差异无统计学意义(均P>0.05);而2组非声门型患者的5年生存率比较(开放组62.5%vs微创组0),差异有统计学意义(P<0.05)。微创组中,有3例出现并发症,其中发热1例,肺部感染2例;开放组中,有14例出现并发症,其中发热5例,肺部感染7例,咽瘘2例。微创组患者并发症发生率(6.82%,3/44)低于开放组(24.60%,14/57),差异有统计学意义(P<0.05);微创组Ⅱ期及声门型患者的并发症发生率均显著低于开放组(P<0.05)。2组患者复发率(开放组10.53%vs微创组2.27%)比较,差异无统计学意义(P>0.05)。结论与开放式部分喉切除术相比,二氧化碳激光喉切除治疗早中期喉恶性肿瘤,患者术后恢复更快,并发症发生率低,值得推广。

Objective To compare the effects and complications of carbon dioxide laser laryngectomy and open partial laryngectomy in the treatment of laryngeal carcinoma.Methods Clinical data of 101 patients with stageⅠ-Ⅲlaryngeal squamous cell carcinoma admitted to Renji Hospital,Shanghai Jiao Tong University School of Medicine from January 2013 to January 2018 were selected and divided into open surgery group and minimally invasive group according to different surgical methods.The open surgery group received open partial laryngectomy(57 cases),and the minimally invasive group received carbon dioxide laser laryngectomy(44 cases).Follow-up visits were made by telephone and outpatient visits,and the operation time,postoperative laryngeal mucosa edema time,length of stay,5-year survival rate,complication rate and recurrence rate of the two groups were compared in the different clinical stages(stageⅠ,stageⅡ,and stageⅢ)and tumor locations(glottic type and non-glottic type).Results The operation time,postoperative laryngeal mucosa edema time and length of stay of the minimally invasive group were shorter than those of the open surgery group(P<0.05).Comparison of the 5-year survival rates of patients with the same clinical stage and glottic type between the two groups showed no statistically significant difference(both P>0.05);while comparison of the 5-year survival rates of patients with non-glottic type between the two groups(62.5%in the open surgery group vs 0 in the minimally invasive group)showed a statistically significant difference(P<0.05).In the minimally invasive group,there were 3 cases of complications,including 1 case of fever and 2 cases of lung infection;in the open surgery group,there were 14 cases of complications,including 5 cases of fever,7 cases of lung infection and 2 cases of pharyngeal fistula.The complication rate of patients in the minimally invasive group(6.82%,3/44)was lower than that in the open surgery group(24.60%,14/57),and the difference was statistically significant(P<0.05);the complication rate of patients with stageⅡand glottic type in the minimally invasive group was significantly lower than that in the open surgery group(P<0.05).Comparing the recurrence rate of patients in the two groups(10.53%in the open surgery group vs 2.27%in the minimally invasive group),the difference was not statistically significant(P>0.05).Conclusion Compared with open partial laryngectomy,carbon dioxide laser laryngectomy has faster postoperative recovery and lower complication rate in the treatment of early and middle laryngeal malignant tumors,so it is worth promoting.