中-重度不典型增生喉癌癌前病变的治疗探讨

Treatment of laryngeal precancerous lesions with pathologic changes of moderate to severe dysplasia

目的提高对中-重度不典型增生喉癌癌前病变的认识,选择恰当的方法治疗中-重度不典型增生喉癌癌前病变。方法选取经病理证实的29例喉中-重度不典型增生癌前病变患者,其中26例采用喉内镜下声带黏膜剥脱术治疗,3例采用喉裂开下喉部分切除术治疗。所有患者术后均随访3年以上,若出现恶变者则至恶变时为此研究随访结束时间。结果 17例一次性治愈;2例复发,采用喉裂开下喉部分切除术治愈;10例癌变,此患者之后按肿瘤分期分别行开放性手术。结论病理为中-重度不典型增生的喉癌癌前病变恶变率高,采用支撑喉镜下声带黏膜剥脱术治疗喉癌癌前病变仍有较高的治愈率,但术后必须严格随诊。

Objective To improve the cognition of laryngeal precancerous lesions with pathologic changes ofmoderate to severe dysplasia and to select proper treatment strategy for these lesions. Methods Moderate to severelaryngeal dysplasia was pathologically confirmed in 29 patients. Of them, 26 cases received primary laryngealendoscopic mucosal denudation of vocal cord and 3 cases were treated with primary partial laryngectomy vialaryngofission approach. All the patients had been followed up for more than 3 years postoperatively, and the follow-up would be ended once the lesion got malignant change. Results In the 26 patients underwent mucosal stripping ofvocal cord, 17 were healed and 2 recurrent cases were cured with partial laryngeetomy via laryngofission. 10 caseswith malignant change were surgically treated via open operation based on tumor stage. Conclusions Malignant rate oflaryngeal precancerous lesions with pathologic changes of moderate to severe dysplasia is high. With high curativerate, laryngeal endoscopic mucosal denudation of vocal cord is the chief treatment and strict postoperative follow-upshould be emphasized.