低温等离子射频消融与喉部分切除术治疗早期声门型喉癌的疗效比较

Efficacy analysis of low-temperature plasma radiofrequency ablation and partial laryngectomy for early glottic carcinoma

目的比较低温等离子射频消融与喉部分切除术治疗早期声门型喉癌的疗效。方法回顾性分析2013年8月—2018年7月蚌埠医学院第一附属医院耳鼻咽喉头颈外科收治的60例早期声门型喉癌患者的临床资料。按治疗方式不同分为两组:等离子射频消融术30例(等离子组),均为男性,年龄52~74岁;喉部分切除术30例(喉部分切除组),均为男性,年龄53~72岁。对两组患者手术时间、术中失血量、术后疼痛视觉模拟评分法(VAS)评分、术后住院时间、黏膜恢复得分、并发症发生及喉功能恢复情况进行比较分析。结果(1)等离子组手术时间、术中失血量、术后疼痛VAS评分、术后住院时间、黏膜恢复得分分别为(12.56±2.34)min、(8.72±1.31)mL、(4.35±1.26)分、(3.53±1.41)d、(6.25±1.32)分,与喉部分切除组的(100.00±8.34)min、(80.71±1.05)mL、(5.37±1.12)分、(11.45±1.05)d、(3.25±1.34)分比较,差异均有统计学意义(t=55.291、234.873、3.311、24.682、8.741,P值均<0.01)。(2)术后并发症比较:等离子组呛咳评分为(3.53±0.75)分,与喉部分切除组的(6.01±1.12)分比较差异有统计学意义(t=10.077,P<0.01);等离子组术后感染发生率、肉芽增生发生率、复发率分别为0、16.67%(5/30)、3.33%(1/30),与喉部分切除组的6.67%(2/30)、10.00%(3/30)、3.33%(1/30)比较,差异均无统计学意义(P值均>0.05)。(3)喉功能恢复情况:等离子组基频微扰(Jitter)、振幅微扰(Shimmer)及谐噪比(HNR)术前分别为0.82%±0.15%、6.37%±1.23%和(12.86±2.21),术后1年分别为0.61%±0.14%、4.62%±1.21%和(17.69±2.41);喉部分切除组Jitter、Shimmer和HNR术前分别为0.91%±0.27%、6.34%±1.01%和(13.19±2.66),术后1年分别为0.76%±0.17%、5.54%±0.96%和(16.01±1.57)。两组患者Jitter、Shimmer、HNR术前差异均无统计学意义(P值均>0.05),术后1年差异均有统计学意义(P值均<0.01);两组患者术后1年的Jitter、Shimmer低于术前,HNR高于术前,差异均有统计学意义(P值均<0.05)。结论支撑喉镜下低温等离子射频消融术在早期声门型喉癌的治疗应用中,具有手术时间短、手术失血量少、住院时间短、术后黏膜及嗓音恢复较好等优势,术后呛咳发生率低的特点,值得临床推广应用。

Objective To determine the curative effects of low-temperature plasma radiofrequency ablation and partial laryngectomy for early glottic carcinoma.Methods Sixty patients with early glottic carcinoma who were admitted to the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Bengbu Medical College from August 2013 to July 2018 were retrospectively analyzed.The patients were divided into two groups according to treatment modality.Thirty cases(plasma group)were treated with plasma radiofrequency ablation(all male,aged 52-74 years old),and 30 cases(partial laryngectomy group)were treated with partial laryngectomy(all male,aged 53-72 years old).Operation time,intraoperative blood loss,postoperative pain visual analogue scale(VAS)score,postoperative hospital stay,mucosal recovery,complications,and laryngeal function recovery were compared and analyzed between the two groups.Results(1)The operation time,intraoperative blood loss,postoperative pain visual analogue scale(VAS)score,postoperative hospital stay duration,and mucosal recovery scores were(12.56±2.34)min,(8.72±1.31)mL,(4.35±1.26)points,(3.53±1.41)days,and(6.25±1.32)points,respectively,in the plasma group.They were(100.00±8.34)min,(80.71±1.05)mL,(5.37±1.12)min,(11.45±1.05)days,and(3.25±1.34)points,respectively,in the partial laryngectomy group,and the differences were statistically significant(t=55.291,234.873,3.311,24.682,8.741,respectively;all P values<0.01).(2)As for the postoperative complications,the choke cough score was(3.53±0.75)points in the plasma group and(6.01±1.12)points in the partial laryngectomy group,and the difference was statistically significant(t=10.077,P<0.01).The incidences of infection,granulation tissue hyperplasia,and recurrence after operation in the plasma group were 0,16.67%(5/30),and 3.33%(1/30),respectively,after plasma radiofrequency ablation and 6.67%(2/30),10.00%(3/30),and 3.33%(1/30),respectively,after partial laryngectomy,and the differences between these incidences were not significant(all P values>0.05).(3)As for the laryngeal function recovery,the fundamental frequency(Jitter),amplitude(Shimmer),and harmonic-to-noise ratio(HNR)in the plasma group were 0.82%±0.15%,6.37%±1.23%,and 12.86±2.21,respectively,pre-surgery and 0.61%±0.14%,4.62%±1.21%,and 17.69±2.41,respectively,a year post-surgery.The Jitter,Shimmer,and HNR values in the partial laryngectomy group were 0.91%±0.27%,6.34%±1.01%,and 13.19±2.66,respectively,before surgery and 0.76%±0.17%,5.54%±0.96%,and 16.01±1.57,respectively,a year post-surgery.No significant difference was observed in the preoperative Jitter,Shimmer,and HNR values between the two groups(all P values>0.05).The differences between the two groups 1 year after operation were statistically significant(P<0.01).The Jitter and Shimmer values in the two groups were lower and HNR was higher 1 year after surgery than before surgery,and the differences were statistically significant(all P values<0.05).Conclusions Low-temperature plasma radiofrequency ablation under self-retaining laryngoscope in the treatment of early glottic carcinoma has the advantages of short operation time,less operation blood loss,short hospital stay,good recovery of postoperative mucosa and voice,and low incidence of postoperative cough and is therefore worthy of clinical promotion and application.