经口CO2激光术、喉部分切除术和低温等离子射频消融术治疗声门型喉癌的疗效观察

Efficacy of oral CO2 laser surgery,partial laryngectomy and low-temperature plasma radiofrequency ablation for glottic laryngocarcinoma

目的探讨经口CO2激光术、保留甲状软骨的喉部分切除术和低温等离子射频消融术治疗声门型喉癌患者的疗效。方法选取2018年8月至2020年2月间辽宁盘锦市中心医院收治的134例声门型喉癌患者,采用随机数表法分为激光组47例、部分切除组45例和等离子组42例。激光组患者采用经口CO2激光术,部分切除组采用保留甲状软骨的喉部分切除术,等离子组采用低温等离子射频消融术治疗,比较三组患者术中出血量、创面恢复时间、手术时间、术后复发率和生存率。结果激光组患者术中出血量低于部分切除组和等离子组,部分切除组患者术中出血量和手术时间均高于激光组和等离子组,等离子组手术时间短于激光组,差异均有统计学意义(均P<0.05)。术后3个月,三组患者嗓音障碍指数量表(VHI)评分均高于术前,差异均有统计学意义(均P<0.05)。术后6个月,三组VHI评分均低于术后3个月,等离子组患者VHI评分低于部分切除组和激光组,差异均有统计学意义(均P<0.05)。三组患者局部复发率和1年生存率比较,差异均无统计学意义(P>0.05)。结论经口CO2激光术、保留甲状软骨的喉部分切除术和低温等离子射频消融术均能有效改善声门型喉癌患者的嗓音功能障碍,低温等离子射频消融术可缩短手术时间,且术后6个月嗓音恢复效果最优。

Objective To discuss the efficacy of oral CO2 laser surgery,partial laryngectomy and low-temperature plasma radiofrequency ablation for glottic laryngocarcinoma.Methods A total of 134 patients with glottic laryngocarcinoma treated at Panjin Central Hospital from August 2018 to February 2020 were selected as the main research subjects.They were divided into a laser group(47 patients),a partial resection group(45 patients)and a plasma group(42 patients).Patients in the laser group underwent oral CO2 laser surgery.Patients in the partial resection group underwent partial laryngectomy with conservation of thyroid cartilage.Patients in the plasma group underwent low-temperature plasma radiofrequency ablation.The intraoperative blood loss,wound recovery time and duration of operation,recurrence rate and survival rate were compared among the three groups.Results The amount of blood loss was lower in the laser group than in the partial resection group and the plasma group(P<0.05).The intraoperative bleeding volume and duration of operation were higher in the partial resection group than in the rest two groups(all P<0.05).The duration of operation was shorter in the plasma group than in the rest two groups(all P<0.05).At 3 months after the operation,scores of voice handicap index(VHI)were higher in the three groups than those before the operation(all P<0.05).At 6 months after the operation,scores of VHI were higher in the three groups than those at 3 months after the operation(all P<0.05).The score of VHI was lower in the plasma group than in the rest two groups(all P<0.05).There was no significant difference in local recurrence and 1-year survival between the two groups(P>0.05).Conclusion All three methods can effectively improve the voice function in patients with glottic laryngocarcinoma,among which low temperature plasma radiofrequency ablation can shorten the duration of operation with best recovery of voice at 6 months after the operation.