等离子点状激发射频消融技术治疗早期声门型喉癌(T_(is)-T_(1b))31例

Application of radiofrequency ablation with plasma spot excitation in early glottic carcinoma (T_(is)-T_(1b))

目的探讨等离子点状激发射频消融技术治疗早期声门型喉癌(T_(is)-T_(1b))的疗效。方法收集58例早期声门型喉癌(T_(is)-T_(1b))患者,均为男性,根据手术方式分为两组。等离子手术组31例,平均(52.1±8.7)岁,TNM分期为T_(is)6例,T1a23例,T_(1b)2例;CO_(2)激光手术组27例,平均(55.6±10.3)岁,TNM分期为T_(is)3例,T1a22例,T_(1b)2例。随访6~18个月,记录手术时间、术后疼痛评分和呛咳评分,术后1、3、6个月复查电子喉镜。结果 ①等离子组手术时间(11.81±2.97)min低于接受CO_(2)激光组(16.77±2.71)min(P<0.001)。两组患者住院时间、术中出血量、疼痛评分、呛咳评分、前联合粘连率、肉芽增生发生率比较差异均无统计学意义(P=0.676,0.390,0.483,0.483,0.094,0.788);②术后所有患者均获得门诊随访,随访期(6~18个月)内无死亡病例。4例患者局部复发,其中等离子组1例T1a, 1例累及前联合为T1b,均再次行等离子手术;CO_(2)激光组2例均累及前联合,其中1例再次行CO_(2)激光扩大切除;1例合并单侧颈部淋巴结转移,改行环舌根吻合术并择区颈部淋巴结清扫术,随访期内均无复发。两组患者局部复发率差异均无统计学意义(P=0.276);③所有患者术后不同时间点的声学参数指标Jitter、Shimer和NHR均逐渐恢复(均P<0.05);等离子组术后嗓音学参数恢复优于CO_(2)激光组(P=0.000,0.001,0.000)。结论低温等离子点状激发射频消融技术治疗早期声门型喉癌(Tis-T1b)是值得探讨的一种方法,具有手术时间短、黏膜损伤小、嗓音功能保存好等优点,但远期肿瘤控制率及生存率有待进一步观察。

Objective This study aimed to evaluate the efficacy of radiofrequency coblation(RFC) in the treatment of early glottic carcinoma(T_(is)-T_(1b)). Methods A total of 58 patients with early glottic carcinoma(T_(is)-T_(1b)) at People?s Hospital were enrolled from October 2018 to April 2020. All patients were men. According to the surgical method, 31 and 27 patients were included in the RFC and CO_(2) laser groups, respectively. The average patient age was 52.1±8.7 and 55.6±10.3 years in the RFC and CO_(2) laser groups, respectively. In the RFC group, the tumor-node-metastasis(TNM) stage was T_(is), T1 a, and T_(1b) in 6, 23, and 2 patients, respectively, while in the CO_(2) laser surgery group, the TNM stage was T_(is), T1 a, and T_(1b) in 3, 22, and 2 patients, respectively. All patients were followed up for 6-18 months, and the operation time, postoperative pain score, and cough score were recorded. All patients underwent reassessment at 1, 3, and 6 months after surgery using an electronic laryngoscope. Results The operation time was shorter in the RFC group than in CO_(2) laser group(11.81 vs. 16.77 min, P<0.001). There were no significant differences in the length of hospital stay, blood loss, pain score, cough score, anterior conglutination rate, and granulomatous hyperplasia between the groups(P=0.676,0.390,0.483,0.483,0.094,0.788). All patients were followed up in the outpatient department. No deaths occurred during the follow-up period. Four patients developed local recurrence, including 2 patients(1 patient with T1b involving anterior commissure and 1 patient with T1a) in the RFC group and 2 patients(2 patients with T_(1b) involving anterior commissure) in the CO_(2) laser group. Both patients in the RFC group underwent repeat plasma surgery and 1 patient in the CO_(2) laser group underwent CO_(2) laser extended resection. In one patient with unilateral cervical lymph node metastasis, the surgery was converted to open surgery. There was no significant difference in the local recurrence rate between the groups(P=0.276). The acoustic parameters of Jitter, Shimer, and NHR recovered gradually in all patients at different time points postoperatively(P<0.05), and the acoustic parameters of the RFC group were better than those of the CO_(2) laser group(P=0.000,0.001,0.000). Conclusion Radiofrequency ablation with the plasma spot excitation technique is safe and effective for the treatment of early glottic carcinoma(T_(is)-T_(1b)). It has the advantages of short operation time, small mucosal injury, and good preservation of voice function. However, the long-term tumor control rate and survival rate need to be further observed.