经口CO_(2)激光手术治疗早期声门型喉鳞状细胞癌的疗效分析

Efficacy of transoral CO2 laser surgery for early glottic squamous cell carcinoma of the larynx

目的:分析用经口CO_(2)激光手术治疗早期声门型喉鳞状细胞癌的疗效。方法:分析2010年1月至2019年6月肇庆市第一人民医院接诊的25例声门型喉鳞状细胞癌患者的临床资料。对这些患者均进行经口CO_(2)激光手术,然后观察其术后并发症的发生情况、肿瘤局部复发情况及喉功能的恢复情况。结果:这25例患者均为男性;其中有T1aN0M0声门型喉鳞状细胞癌患者15例,T1bN0M0声门型喉鳞状细胞癌患者8例,T2N0M0声门型喉鳞状细胞癌患者2例;其中存在肿瘤侵犯前联合情况的患者有10例。这些患者术后均存在明显的声音嘶哑症状,吞咽无呛咳;其中无出现活动性出血、呼吸困难或接受气管切开的患者;其中有6例患者于术后6个月后出现声带前联合处粘连,未进行外科处理;2例患者于术后3~4个月出现声门后区肉芽肿,再次行激光切除。在随访期间,这些患者中有24例患者达到术后无瘤生存的目标,有1例患者于手术4年后病情复发,行气管切开+双侧颈淋巴清扫+喉部分切除+钛合金支架喉成形术,术后追加放疗,至今已无瘤生存半年。结论:用经口CO_(2)激光手术治疗早期声门型喉鳞状细胞癌的疗效确切。

Objective:To analyze the efficacy of transoral CO_(2)laser surgery for early glottic squamous cell carcinoma of the larynx.METHODS:The clinical data of 25 patients with glottic laryngeal squamous cell carcinoma admitted to Zhaoqing First People’s Hospital from January 2010 to June 2019 were analyzed.All of these patients underwent transoral CO_(2)laser surgery,and the incidence of postoperative complications,local recurrence of tumor and recovery of laryngeal function were observed.Results:All the 25 patients were male.There were 15 patients with T1AN0M0 glottic squamous cell carcinoma,8 patients with T1BN0M0 glottic squamous cell carcinoma,and 2 patients with T2N0M0 glottic squamous cell carcinoma.There were 10 patients with preinvasive combination of tumor.All these patients had obvious hoarseness symptoms after surgery,without choking when swallowing.There were no patients with active bleeding,dyspnea or tracheotomy.There were 6 cases of anterior vocal cord adhesion 6 months after surgery,and no surgical treatment was performed.Two patients developed granuloma in the retroglottic region 3 to 4 months after surgery and were resected again by laser.During the follow-up period,24 of these patients achieved the goal of tumor-free survival after surgery,and 1 patient relapsed 4 years after surgery and received tracheotomy+bilateral neck lymph dissection+partial laryngectomy+titanium alloy stent laryngoplasty with postoperative radiotherapy,so far,he has been tumor-free for half a year.Conclusion:Tra nsoral CO_(2)laser surgery is effective in the treatment of early glottic s quamous cell carcinoma of the larynx.