二氧化碳激光喉乳头状瘤切除术的临床研究

Clinical Study of Carbon Dioxide Laser in Treating Laryngeal Papilloma

目的探讨二氧化碳（CO2）激光切除喉乳头状瘤的临床疗效，分析其复发的临床相关因素。方法回顾分析2003年2月一2010年10月喉乳头状瘤患者102例，分为未成人组70例及成人组32例，均采用全身麻醉下支撑显微喉镜CO2激光切除病变。观察记录两组患者的病变及复发部位、复发时间、术后声带粘连发生情况、恶变情况等。结果所有患者随访1～8年，发生声带粘连11例，均为前联合有病变者，占前联合病变者27．5％。发生恶变4例，均发生在成人组，成人组恶变率12．5％。术后复发41例，76例次，其中复发5次者2例，复发4次者4例，3次者3例，2次者9例，1次者23例。未成人组与成人组复发率差异有统计学意义（P〈0．05）；未成人组及成人组内单发病变与多发病变间复发率差异有统计学意义（P〈0．05）；未成人单发病变组与成人单发病变组间复发率差异无统计学意义（P〉0．05）；未成人多发病变组与成人多发病变组间复发率差异有统计学意义（P〈0．05）；未成人组与成人组首次复发时间均发生在术后12个月内，尤其集中在术后6个月内；单发病变和多发病变患者复发部位分别以前联合病变（2／3，66．7％）及声门下病变（5／6，83．3％）为第一位。结论支撑显微喉镜CO2激光喉乳头状瘤切除术，安全、有效、微创，是目前喉乳头状瘤治疗中的首选外科方法，但仍有需改进的地方。

Objective To investigate the clinical efficacy of carbon dioxide （CO：） laser ablation in the treatment of laryngeal papilloma and analyze the relevant factors for recurrence. Methods We retrospectively analyzed the clinical data of 102 patients with laryngeal papilloma treated between February 2003 and October 2010 in our department. They were divided into the juvenile group （n=70） and adult group （n=32）. Patients in both groups underwent microsurgery with CO2 laser ablation to remove the lesions under general anesthesia. During the process, we observed patients＇ site of lesions, recurrence time, the incidence of postoperative vocal adhesions, and the occurrence of malignancy. Results All patients were followed up for 1 to 8 years. Eleven cases of vocal cord adhesion occurred, and patients with the adhesion all had former joint lesions, which accounted for 27.5% of all the anterior commissure adhesion patients. Four cases of malignancy all occurred in adults with an adult malignancy rate of 12.5%. Recurrence occurred in 41 cases and 76 cases of times, including 5 times in 2 cases, 4 times in 4 cases, 3 times in 3 cases, twice in 9 cases, and once in 23 cases. The difference in times of recurrence was significant between the juvenile and the adult group （P 〈 0.05）. Significant difference was found between single lesion and multiple lesion recurrence in both groups （P 〈 0.05）. There was no significant difference between the two groups in terms of single lesion recurrence （P 〉 0.05）, while the difference in multiple lesion occurrence was significant （P 〈 0.05）. The first recurrence time was within 12 months after surgery in both groups, and recurrence mainly occurred within 6 months after surgery. Single lesion and multiple lesion recurrence mainly manifested as anterior commissure lesions （2/3, 66.7%） and subglottic lesions （5/6, 83.3%） respectively. Conclusion Micro-larynagoscopy CO2 laser laryngeal papilloma resection is safe, effective, and minimally invasive in the treatment of laryngeal papilloma, and is the preferred surgical method in clinic, but it still needs further improvement.