T_1声门癌CO_2激光声带切除深度的探讨

The depth of CO_2 laser cordectomy in T_1 glottic carcinoma

目的：探讨内镜CO2激光声带切除术治疗T1声门型喉癌是否应常规切除甲杓肌。方法：回顾性分析内镜CO2激光治疗T1声门型喉癌57例患者的临床和病理资料。其中Tis 7例,T1a47例,T1b3例;声带切除术Ⅰ、Ⅱ型9例,Ⅲ、Ⅳ、Ⅴ型48例。将48例包括甲杓肌的声带切除标本病理切片进行重新阅片。生存率的计算用Kaplan-Meier方法。结果：随访4~119个月（平均41.5个月）,死亡4例,失访8例,5年生存率89.1%,5年疾病别生存率96.3%,5年无瘤生存率78.1%。局部复发10例（17.5%）,颈部转移1例,甲杓肌受侵5例（8.8%）。挽救手术包括：喉部分切除术6例,喉全切除术3例,颈淋巴结清扫术1例,喉全切除术及颈淋巴结清扫术1例。术后放疗2例。喉保存率93.0%（53/57）。结论：T1声门癌可侵及甲杓肌,内镜CO2激光声带切除治疗T1声门癌时,甲杓肌的切除应根据术前和术中肿瘤的范围和侵润深度,分别实施不同类型的切除。正确判断肿瘤的范围和甲杓肌受侵深度有助于减少术后局部复发和提高发声质量。

Objective：To evaluate if routine resection of thyroarytenoid muscle（TA） with T1 glottic carcinoma treated by endoscopic CO2 laser cordectomy is necessary.Method：A cohort of 57 patients staged as T1 underwent endoscopic CO2 laser cordectomy at a single institution was retrospectively analyzed.Seven had Tis,47 T1a and 3 T1b;9 cases were treated with type Ⅰ or Ⅱ cordectomies,and 48 patients underwent type Ⅲ,Ⅳ or Ⅴ cordectomies,with resection of all or part of the TA.All histological slides from the 48 patients were re-examined under the light microscope for TA invasion by the pathologist and the surgeon.Survival and local control were calculated using the Kaplan-Meier method.Result：The follow-up period for the 57 patients ranged from 4 to 119 months（mean follow-up 41.5 months）.Among the 4 patients who died,1 of them was related to the glottis carcinoma and 3 others had died of other causes with no evidence of locoregional glottic disease.The 5 year overall survival,5 year disease-specific survival and 5 year disease-free survival were 89.1%,96.3% and 78.1%,respectively.When the study ended,10（17.5%） local and 1 regional recurrences had been observed.Over a total of 57 patients,5（8.8%） cases showed TA invasion.Open salvage therapy was performed during follow-up.Six patients had partial laryngectomy.Four patients had total laryngectomy and one with neck dissection.One patient had radical neck dissection because of late regional relapse was proven by histopathologic examination.Thus,the larynx was preserved in 93.0%（53/57）.Conclusion：TA invasion found histologically in T1 glottic carcinoma.TA resection can be performed conservatively according to an accurate preoperative and intraoperative evaluation of macroscopic tumour extension.