CO2激光显微手术在喉癌前病变和早期声门型喉癌中的应用

Applications of CO laser microsurgery on laryngeal precancerous lesions and early glottic laryngeal carcinoma

目的探讨CO2激光显微手术在喉癌前病变和早期声门型喉癌治疗中的应用价值。方法选取南京医科大学附属南京医院耳鼻咽喉科自2014年1月~2018年8月期间收治的27例行CO2激光显微手术治疗的喉癌前病变(9例)和早期声门型喉癌(18例)作为研究对象,观察术后并发症、对比手术前后的生活质量及术后1~2年局部的复发率,探讨其应用价值。结果根据CO2激光显微手术切除的范围和深度进行手术:9例癌前病变中8例行I型手术、1例行Ⅱ型手术;18例早期声门型喉癌中3例行Ⅱ型手术、11例行Ⅲ型手术、3例行Ⅳ型手术、1例行Ⅴ型手术。1例因切缘阳性改行开放式手术,其余患者均未行气管切开,亦无气道烧伤等严重并发症。患者术后6 h软食,均无呛咳、呼吸困难等不良反应,术后抗感染抗炎治疗2~3 d。术后随访1~2年,嗓音恢复可。结论CO2激光显微手术治疗喉癌前病变和早期声门型喉癌临床效果显著、安全性较高、创伤小、术后嗓音恢复快、住院时间缩短、并能较为理想的保留喉功能、提高患者术后的生活质量。

Objective This study aimed to investigate the clinical applications of CO2 laser microsurgery for laryngeal precancerous lesions and early glottic laryngeal cancer.Methods A total of 27 patients,nine diagnosed with laryngeal precancerous lesions and 18 with early glottic laryngeal cancer,who had undergone CO2 laser microsurgery were selected from January 2014 to August 2018 from the otolaryngology department of the Nanjing First Hospital(Nanjing Medical University).We observed the postoperative complications,the before and after surgery quality of life,and the postoperative 1~2-year local recurrence rate and evaluated the therapeutic effects of CO2 laser microsurgery.Results Patients were classified into two groups depending on the scope and depth of CO2 laser microsurgical resection.In the precancerous lesions group,eight patients received a type I operation and one patient received a type II operation.In the glottic laryngeal cancer group,three patients received a type II operation,11 patients received a type III operation,three patients received a type IV operation,and one patient received a type V operation.One patient underwent open surgery because the surgical margin was positive.None of the other patients underwent tracheotomy,and no serious complications such as airway burns were noted.The patients were offered soft food six hours after surgery;no adverse reactions such as choking or dyspnea were observed.Further,the patients received anti-infective and anti-inflammatory treatment for 2-3 days after surgery.The patients were followed up for 1~2 years postoperatively.The voices of the patients recovered after the operation.Conclusion CO2 laser laryngeal microsurgery has significant clinical applications in the treatment of laryngeal precancerous lesions and early glottic laryngeal carcinoma,leading to increased safety,less trauma,faster voice recovery,and shorter hospitalization times,in turn leading to larynx function preservation and improvements in the postoperative quality of life.