前联合在早期声门型喉癌激光微切中的临床意义

Clinical Importance of Anterior Commissure in Early Glottic Cancer after Laser Endoscopic Resection

目的分析声门型喉癌(T_(1a)-T_2)激光微切后前联合在喉功能恢复、复发及治愈率方面的影响。方法随访性研究56例早期声门型喉癌患者激光微切治疗后前联合的作用及局部复发率及喉功能恢复情况。结果癌细胞累及前联合28例,局部治愈率78%(22例);喉功能保护率96%(27例);无前联合累及28例中治愈率为96%(27例),喉功能保护率为100%.局部复发率前联合被累及者22%(6例)、无累及3.5%(1例),两者差异无显著性(P>0.05)。前联合累及者发生阳性切缘35%(10例),通过连续病理切片发现有癌细胞浸润和T_1期前联合可疑采取保守治疗的患者有更高的复发率。结论早期声门型喉癌如有前联合的涉及,如果激光手术切除不彻底,患者复发率将增加,高复发率在T_1期患者将明显增加。

Objective To analyze the impact of anterior commissure involvement on rates of local control, recurrence ant] laryngeal preservation in patients with early glottic cancer（ Tla-T2 lesions） treated with laser microsurgieal resection. Methods Fifty-six patients with early glottic （ T1-T2a } cancer were reviewed retrospectively, and the local control and larynx preservation rates were valued. Results Among 56 patients presenting with early glottic cancer,the anterior commissure was inw）lved in 28 cases. The loeal control rate was 78% （22 cases） , and the larynx preservation rate was 96% （27 cases）. In the 28 cases without anterior commissure involvement, the local control rate was 96% （27 cases） and the corresponding larynx preservation rate was 100% {28 cases）. The rate of local recurrence with anterior eommissure involvement was 22%（ 6 cases ） and was 3.5% （ 1 case） when this site was not compromised by the tumor. The difference was not statistically significant （ P 〉 0.05 ）. When the anterior commissure was compromised by a lesion, positive surgical margins were 35% （ 10eases ）. Cases with additional margins compromised by squamous cell carcinoma （SCC） on permanent section and T1 lesions had a higher rate of recurrence. Conclusion This study shows the tendency toward greater additional margins compromised by SCC, and a higher rate of tumor recurrence in lesions with anterior commissure, inw）lvement after laser microsurgery for early glottic carcinoma. Higher recurrence rates are observed in cases with compromised additional margins and in T1cases.