早期声门型喉癌的治疗选择:放疗或手术治疗?

Treatment of Early Glottic Carcinoma: Radiotherapy or Endoscopic Surgery?

目的探讨早期声门型喉癌的首选治疗方法。方法对1例早期声门型喉癌的诊疗过程进行回顾性分析。结果本例因声音嘶哑在外院就诊诊断为声门型喉癌(T1N0M0),于全麻下行支撑喉镜下CO2激光辅助声带切除术,术后予根治性放疗,放疗后因呼吸困难而行气管切开术,声带切除术后10个月出现痰中带血,时有烂肉样组织咳出而转我院。行正电子发射型计算机断层扫描(PET-CT)排除喉癌复发,考虑为放疗后喉坏死,后因咯血加重,于声带切除术后11个月在全麻下行喉全切除术,术中见喉内组织大面积坏死,术后伤口愈合差,坏死形成咽瘘,喉全切除术后1个月因坏死累及颈部血管出现大出血死亡。结论支撑喉镜下CO2激光治疗和放疗是目前临床治疗早期声门型喉癌的主要方法,前者为首选治疗方法,两者不必联合应用,因联合治疗可增加并发症发生率。

Objective To discuss the first choice of treatment for early glottic carcinoma. Methods The clinical da-ta of one case of early glottic carcinoma was analyzed retrospectively. Results The patient was diagnosed as early glottic cancer （ T1 N0 M0 ） and received transoral CO2 laser assisted cordectomy under general anesthesia at other hospital. Postopera-tive radical radiotherapy was implemented. Tracheotomy was performed to relieve dyspnea after the radiotherapy. The cough started from 10 months after cordectomy and progressed slowly, accompanied by purulent sputum, bloody sputum and a little band-like black necrotic tissue. He was referred to our department because his symptoms were not improved. PET-CT showed no recurrence. For massive hemoptysis, total laryngectomy was performed at 11 months after cordectomy. The larynx showed extensive necrosis during the operation. And the skin and tissue of the front of the neck healed poorly and pharyngeal fistula formed. The patient died from bleeding because of acute rupture of a cervical artery at 1 month after the total laryngectomy. Conclusion Transoral CO2 laser assisted cordectomy and radiotherapy are the main methods of early glottic carcinoma, and the former one may be the first choice. The combined treatment can increase the incidence of complications and is not recom-mended.