经口低温等离子辅助显微外科治疗头颈肿瘤的初步效果

Initial Efficacy of Transoral Coblation Microsurgery for Head and Neck Tumors

目的探讨经口低温等离子辅助显微外科(transoral coblation microsurgery,TCM)治疗头颈肿瘤的初步效果。方法回顾性分析2008年5月至2011年10月间北京协和医院93例TCM治疗头颈肿瘤的手术资料。93例患者中,T1～T2期喉癌43例,喉良性肿瘤14例,口咽和喉咽恶性肿瘤10例,咽良性肿瘤4例,会厌谷囊肿13例,咽旁间隙良性肿瘤9例。11例为开放手术或CO2激光手术后局部复发病例。3例咽癌同期行颈清扫术,18例T2期喉癌和咽癌术后行辅助放疗。结果 93例均达到内窥镜全切除标准。53例恶性肿瘤中,51例一期切除,2例因术后病理结果的变化行二次内镜等离子局部扩大切除;40例良性肿瘤均一期切除。术后并发症包括迟发型出血3例,轻度颈部皮下气肿2例,咽部切口裂开4例,前联合喉蹼和肉芽10例。初步随诊结果示:喉癌中位随访时间14.5个月(2～40个月),局部复发2例。咽恶性肿瘤中位随访时间19个月(6～40个月),1例失访,其余无瘤生存;喉、咽和咽旁间隙良性肿瘤中位随访时间17个月(2～37个月),3例局部复发,均为喉乳头状瘤。结论 TCM可作为头颈肿瘤经口微创手术方法之一,用于良性和T1～T2的早期恶性头颈肿瘤治疗。

Objective To investigate the initial efficacy of transoral coblation microsurgery （TCM） for head and neck tumors.Methods A total of 93 patients treated with TCM at Peking Union Medical College Hospital from May 2008 to October 2011 were retrospectively reviewed.Among them,43 patients were with stage T1-T2 laryngeal cancers,14 with laryngeal benign tumors,10 with oro-hypopharyngeal cancers,4 with benign tumors in the oro-hypopharynx,13 with vallecular cysts,and 9 with benign tumors in the parapharyngeal space.Eleven patients had recurrent primary tumors following endoscopic or open-neck resections.Three patients had neck dissections,and 18 patients with stage T2 laryngeal cancers or oro-hypopharyngeal cancers received adjuvant radiotherapy.Results Total resection was achieved endoscopically in all the patients.Among 53 cases with malignant neoplasms,51 cases underwent one-stage resection,and 2 cases underwent subsequent extended local resection according to the pathological results from the one-stage resection.As for the 40 cases with benign tumors,one-stage resection was achieved in all cases.The complications included postoperative hemorrhage in 3 cases,subcutaneous emphysema in 2 cases,dehiscence of the pharyngeal wounds in 4 cases,and laryngeal web or granulation in 10 cases.Patients with laryngeal cancers were followed up 2-40 months （median,14.5 months）,and 2 patients suffered local recurrence.Patients with pharyngeal malignant neoplasms were followed up 6-40 months （median,19 months）,1 patient was lost and the others were disease-free.Patients with benign tumor in larynx,pharynx,and the parapharyngeal space were followed up 2-37 months （median,17 months）,and 3 patients with laryngeal papilloma suffered local recurrence.Conclusion TCM is a safe and effective treatment alternative for selected early malignant neoplasms at stage T1-T2 or benign tumors of head and neck.