CO2激光治疗喉部良、恶性病变临床分析及相关因素探讨

Clinical analysis and related factors of CO2 laser treatment of benign and malignant laryngeal lesions

目的探讨显微镜支撑喉镜下CO2激光治疗喉部良、恶性病变的手术方法、操作技巧及临床效果。方法 169例喉部良、恶性病变患者采用显微镜支撑喉镜下CO2激光手术切除病变组织,术中根据喉部病变的程度采用不同的手术方式。随访并记录患者术后恢复情况。结果 123例喉部良性病变患者中,声带病变及合并肿物80例,会厌病变及合并肿物43例。46例喉部恶性病变患者中,声带白斑患者34例,声门型喉癌12例。不同性别患者喉部良性病变情况比较差异有统计学意义(P<0.05)。所有患者均一次手术成功,术后均无呼吸困难,均未行气管切开术。随访10个月~3.5年,1例声带息肉病变患者术后7个月复发,再次入院行CO2激光手术治愈,随访1年未再复发;1例失访。1例癌前期病变患者术后1年近前联合处有白斑增生。1例声带息肉患者术后拔管后出现气管痉挛并发症,对症治疗后无不良反应发生。结论显微镜支撑喉镜下CO2激光手术对喉部良、恶性病变的治疗疗效确切,喉功能保留好、视野清晰,术后恢复快。对于癌前期病变及早期声门型喉癌患者,术中需根据具体情况扩大切除范围及安全切缘。

Objective To investigate the surgical methods,operation skills and clinical effects of CO2 laser for laryngeal benign and malignant lesions under self-retaining microlaryngoscope.Methods 169 patients with benign and malignant laryngeal diseases were treated with CO2 laser under self-retaining microlaryngoscope to remove the diseased tissues.Different surgical methods were adopted during the operation according to the degree of laryngeal disease.To follow up and record the patient's postoperative recovery.Results Among the 123 patients with benign laryngeal lesions,80 had vocal cord lesions and combined tumors,and 43 had epiglottic lesions and combined tumors.Among 46 patients with malignant lesions of the larynx,34 were with vocal cord leukoplakia and 12 were with glottic carcinoma.There was statistically significant difference in benign lesions of the larynx between patients of different genders(P<0.05).All patients had no difficulty in breathing after a successful operation,and no tracheotomy was performed.During the follow-up period from 10 months to 3.5 years,one patient with vocal cord polyp lesions relapsed 7 months after surgery,and was re-admitted for CO2 laser surgery.The patients were followed up for one year without recurrence.One patient was lost to follow-up.One patient with precancerous lesions had leukoplakia near the joint at one year after surgery.One patient with vocal cord polyp experienced tracheal spasm complications after extubation,and no adverse reactions occurred after symptomatic treatment.Conclusion CO2 laser surgery under self-retaining microlaryngoscope is effective in the treatment of benign and malignant lesions of the larynx,which has a good postoperative effect of retained larynx function,clearly visual field,and fast postoperative recovery.For patients with precancerous lesions and early glottic laryngeal cancer,the resection range and safe margin should be expanded according to the specific circumstances during the operation.