CO_2激光经口微创手术治疗喉部良、恶性病变

Transoral CO_2 Laser Microsurgery for Benign and Malignant Laryngeal Diseases

目的观察经口显微镜支撑喉镜下CO2激光治疗喉部良恶性病变的临床疗效，探讨激光喉部手术适应证。方法回顾性分析2008年11月～2012年5月经CO2激光治疗的喉部良恶性病变33例。上海得邦得力公司DJL-40C CO2激光机，激光波长为10600nm，脉冲模式0．1s，功率3～8w，光斑直径O．7—1．0mm。CO2激光机通过耦合器与Leica F40手术显微镜连接。良性病变18例，其中声带息肉3例，声带角化1例，喉乳头状瘤6例，声带白斑5例，喉蹼2例，双侧声带麻痹1例。恶性病变15例，其中声门上型喉癌4例，声门型喉癌11例。均采用经口显微镜支撑喉镜下CO2激光治疗。结果良性病变术后随访3—6个月，除1例喉乳头状瘤术后复发行二次激光手术外，其余全部一期愈合。恶性病变术后随访11—28个月，平均19月。术后复发1例，声带粘连1例，其余术后病变清除彻底，喉功能保存良好，无严重并发症发生。结论显微镜支撑喉镜下CO2激光治疗喉部良、恶性病变疗效可靠，能较好地保留喉结构和功能，是治疗喉疾病的重要手段。

Objective To evaluate the indication and clinical effects of transoral CO2 laser microsurgery in the treatment of laryngeal benign and malignant diseases. Methods The data of 33 patients undergoing transoral CO2 laser microsurgery for laryngeal benign and malignant diseases were analyzed retrospectively. Among the 18 cases of benign lesions, there were 3 cases of polyps of vocal cords, 1 case of keratosis of vocal cord, 6 cases of laryngeal papilloma, 5 cases of leukoplakia of vocal cord, 2 cases of laryngeal web and 1 case of bilateral paralysis of vocal cords. Among the 15 cases of malignant diseases, there were 4 cases of supraglottic carcinoma and 11 cases of glottic carcinoma. All patients were treated by transoral CO2 laser microsurgery. Results Benign lesions were followed up for 3 - 6 months. All patients had primary healing except for 1 case of laryngeal papilloma which recurred after the surgery and received another CO2 laser microsurgery. Malignant lesions were followed up for 11 - 28 months, with an average of 19 months. Except for 1 case of recurrence and 1 case of vocal cord adhesion, all the lesions were excised thoroughly and laryngeal function was well kept. No serious complications occurred. Conclusions Transoral CO2 laser microsurgery is highly effective in the treatment of pharyngeal and laryngeal benign and malignant diseases. It has reliable curative effects and preserves pharyngeal and laryngeal function well.