早期声门型喉癌CO_2激光手术治疗

CO_2 laser surgery for early glottic carcinoma

目的总结探讨在支撑显微喉镜下通过CO2激光微创手术治疗早期声门型喉癌的疗效。方法对2007年1月~2012年12月于福建省立医院耳鼻咽喉头颈外科接受CO2激光手术治疗的91例早期声门型喉癌患者进行回顾性分析。结果全部患者CO2激光手术后随访25~96个月,2例患者失访(视为死亡),1例患者于术后81个月死于肺癌,喉功能保留率为96.70%(88/91);10例患者出现局部复发,复发率为11.00%(10/91),T1a复发率为12.12%(4/33),T1b复发率为9.10%(3/33),T2复发率为20.00%(3/15),组间差异无统计学意义(χ2=2.645,P>0.05)。前连合受累患者的复发率为28.57%(6/21),前连合未受累的患者复发率为5.71%(4/70),两组比较差异有统计学意义(χ2=8.628,P<0.05)。5年整体生存率为93.20%,局部区域(喉+颈部淋巴结)5年控制率(无肿瘤复发和转移的比率)86.70%。结论支撑喉镜下CO2激光治疗早期声门型喉癌的疗效可靠,创伤小,喉功能保全好,恢复快,并发症少,值得临床推广应用。

OBJECTIVE To explore the efficacy of transoral endoscopic CO2 laser surgery for the early glottic carcinoma. METHODS The clinical data of 91 patients with early glottic carcinoma underwent transoral endoscopic CO2 laser surgery from January 2007 to December 2012 hospitalized in the Department of Otolaryngology of Fujian Provical Hospital of Fujian Medical University were retrospectively studied. RESULTS All patients were followed-up from 25 months to 96 months after operation except 2 patients lost follow up. One patient died of lung cancer 81 months after operation. The total reservation rate of laryngeal function was 96.70%(88/91). Among the 91 cases, recurrence occurred in 10 cases. Recurrent rate of T1 a, T1 b, T2 patients were 12.12%(4/33), 9.10%(3/33) and20.00%(3/15) respectively, with no significant statistical difference among those groups. The recurrent rate was28.57%(6/21) in patients with anterior commissure invaded,while 5.71%(4/70) in patients without anterior commissure invaded(χ 2=8.628, P<0.05). Kaplan-Meier survival analysis shows the overall 5-year survival rate was 93.20%,and the 5-year local-regional control rate was 86.70%.CONCLUSION CO2 laser surgery is a minimally invasive,effective and safe procedure for early glottic cancer, and it is worthy of clinical popularization and application.