早期声门型喉癌CO2激光术后创面的动态观察

Wound healing following laser cordectomy for early glottic carcinoma

目的 探讨CO2激光喉显微手术治疗早期声门型喉癌术后创面愈合过程,嗓音分析,疗效,经济学效益.方法 对2011年1月至2014年6月浙江大学附属第二医院收治的36例T1-T2声门型喉癌CO2激光喉显微手术患者进行创面的内镜动态观察及分析.并收集2008年1月至2014年6月收治的112例行常规开放性手术和27例行放射治疗的T1声门型喉癌患者临床资料,与其肿瘤学疗效、经济学效益进行比较.结果 34例患者行创面愈合形态学观察,黏膜稳定时间平均93 d,120 d内黏膜稳定者为31例（91％）,黏膜稳定时间大于120 d的3例患者中1例复发.31例患者嗓音评估,VHI-10平均得分5.9,T1优于T2,前连合未累及者优于累及者.36例患者,平均随访18.7个月,1、2年总生存率、疾病相关生存率均为100％,局部控制率、喉功能保存率均为94％,与开放性手术、放疗差异无统计学意义（P＞0.05）.与开放性手术、放疗组相比,CO2激光手术组平均住院时间短,平均治疗费用少（P＜0.05）.结论 CO2激光术后创面水肿渗出、肉芽增生明显,创面的动态监测有利于理解喉癌CO2激光术后创面二期愈合过程,避免不必要的干预同时尽早发现可疑病变;CO2激光治疗早期声门型喉癌疗效可靠,经济学效益好.

Objective To study the wound healing following CO2 laser microsurgery for early glottic cancer,and to evaluate the treatment outcomes and cost-effectiveness of microsurgery,open surgery and radiotherapy for early glottic cancer.Methods Thirty-six patients with early glottic carcinoma （T1-T2） treated by transoral CO2 laser microsurgery from January 2011 to June 2014 were observed,and 112 patients undergoing open approach and 27 receiving radiotherapy from January 2008 to June 2014 in our hospital were used as control.The wound healing process,the hospital stay,the cost,the oncologic and functional results were evaluated.Results The mean time of laryngeal mucous membrane stabilization in morphology was 93 days,less than 120 days in 91% cases.The average score of VHI-10 was 5.9,which was better in the cases with T1 than the cases with T2,and was worse in cases with the anterior commissure involvement.Transoral CO2 laser microsurgery offered a similar oncologic result,shorter hospital stay and lower cost compared with open surgery or radiotherapy.Conclusion The transoral laser surgery could be a better choice for early glottic carcinoma because of good oncologic and functional results and less cost.