早期声门型喉癌两种微创治疗疗效比较

Therapeutic effect of two minimally invasive treatments against early glottic carcinoma and influence on patients’ quality of life and laryngeal function

目的探究低温等离子射频消融术和CO2激光手术治疗早期声门型喉癌的疗效及对患者术后生存质量及喉功能改善的影响。方法回顾性分析2014-01至2016-03的83例行支撑喉镜下微创治疗早期声门型喉癌患者资料进行研究,并根据治疗方式不同进行分组,低温等离子射频消融术为观察组,CO2激光手术为观察组。采用SPSS20.0进行数据处理,观察两组手术指标及并发症情况,对比喉功能恢复及嗓音障碍指数,评估术后生活质量。Kaplan-Meier法进行预后分析,评估远期疗效。结果观察组手术时间[(8.5±1.4)vs(12.4±2.3)min]优于对照组(P<0.05),术中出血[(10.6±5.3)vs(11.2±3.8)ml]及术后并发症方面无统计学意义(P>0.05)。术后观察组喉功能恢复(84.2%vs 88.9%)与对照组比较无统计学差异(P>0.05)。观察组声带形态学评分(1.2±0.4 vs 2.0±0.8)及VHI指数优于对照组(P<0.05)。术后1月观察组生活质量各维度评分高于对照组(P<0.05)。术后3年两组复发率(4.4%vs 2.7%)、无病生存率(95.6%vs 97.3%)及总生存率(93.3%vs 92.1%)差异无统计学意义(P>0.05)。结论低温等离子射频消融术和CO2激光术均为治疗早期声门型喉癌的有效方式,但低温等离子射频消融术在术后生活质量及嗓音/声带保护方面较CO2激光术更具优势,值得推广。

Objective To investigate the efficacy of low-temperature plasma radiofrequency ablation and CO2 laser surgery against early glottic laryngeal cancer and the effect on postoperative quality of life and laryngeal function of patients.Methods The data on 83 patients with early glottic laryngeal cancer treated with minimally invasive propping laryngoscopy between January 2014 and March 2016 was retrospectively analyzed.These patients were grouped according to treatments.SPSS20.0 was used for data processing.The surgical indicators and complications of the two groups were observed,laryngeal function recovery and voice disorder index were compared,and postoperative quality of life was evaluated.The Kaplan-Meier method was used to analyze the prognosis and evaluate the long-term efficacy.Results The duration of surgery[(8.5±1.4)vs(12.4±2.3)min]in the observation group was shorter than in the control group(P<0.05),but there was no significant difference in intraoperative bleeding[(10.6±5.3)vs(11.2±3.8)ml]or postoperative complications(P>0.05).Postoperative laryngeal function recovery in the observation group(84.2%vs 88.9%)was not significantly different from that in the control group(P>0.05).The score of vocal cord morphology(1.2±0.4 vs 2.0±0.8)and VHI index of the observation group were better than in the control group(P<0.05).The score of each dimension of life quality in the observation group one month after operation was higher than that of the control group(P<0.05).There was no significant difference in the recurrence rate(4.4%vs 2.7%),disease-free survival rate(95.6%vs 97.3%)or overall survival rate(93.3%vs 92.1%)between the two groups three years after surgery(P>0.05).Conclusions Low temperature plasma radiofrequency ablation and CO2 laser are effective treatments for early glottic laryngeal cancer,but the first approach is more conductive to postoperative quality of life and voice/vocal cord protection,which is worthy of wider application.