早期聲門型喉癌激光顯微切除術的療效分析

Therapeutic effect of laser microsurgery for early glottic laryngeal carcinoma

目的探討早期聲門型喉癌經口支撐喉鏡激光顯微手術的臨床療效。方法總結分析自2007年5月~2017年12月78例接受激光顯微手術的早期聲門型喉癌及部分T3期喉癌患者的臨床資料。2007~2015年採用半導體激光55例,2016~2017年CO_(2)激光23例。其中Tis N0M024例、T1aN0M021例、T1bN0M013例、T2N0M011例、T3N0M09例。結果2例頸部短粗的重度鼾症術前預防性氣管切開,全部病例手術順利,術中均未出現大出血和氣管内燃燒等嚴重手術併發症,術後無出現呼吸困難。其中1例術前氣管切開術的重度鼾症術後1週創面痂殼脫落出血,電凝止血好轉。術後隨訪16個月~120個月,其中1例T3患者於術後16個月頸部淋巴結和肺部轉移而死亡;1例T3術後6月復發而行全喉切除+選擇性頸部淋巴節清掃術;2例T1b於術後8月復發而行部份喉切除+選擇性頸部淋巴節清掃術;2例T2術後10月復發行部份喉切除;目前77例患者生存良好。喉功能保留率92.3%(72/78);Tis復發率0(0/24);T1a0復發率(0/21);T1b復發率15.4%(2/13);T2復發率18.2%(2/11);T3復發率22.2%(2/9)。總復發率7.69%(6/78)。結論經口支撐喉鏡CO_(2)激光顯微手術是治療早期聲門型喉癌的首選方法,手術創傷小,術後恢復快,喉功能保全好,遠期生存率高;該手術對於篩選的部份聲門型T2、T3喉癌也有較好的臨床療效。

Objective To investigate the clinical efficacy of laser microsurgery for glottic laryngeal carcinoma.Methods The clinical data of 78 patients with early glottic laryngeal cancer and several T3 Largngeal carcinoma who underwent laser microsurgery from May 2007 to December 2017 were analyzed.From 2007 to 2015,55 cases of semiconductor lasers and 23 cases of CO_(2) lasers from 2016 to 2017 were used.Among them,there were 24 cases of TisN0M0,21 cases of T1aN0M0,13 cases of T1bN0M0,11 cases of T2N0M0,and 9 cases of T3N0M0.Results Two patients underwent preoperative prophylactic tracheotomy due to short neck and severe snoring.All the cases were operated smoothly.There were no serious complications such as major bleeding and intratracheal burning during operation,and no dyspnea occurred after operation.One patient with severe snoring who underwent preoperative prophylactic tracheotomy had hemorrhage of the wound at 1 week postoperatively,and electrocoagulation stopped bleeding.All patients were followed up for 16 months to 120 months.One patient with T3 died of cervical lymph node and lung metastasis 16 months after surgery.One patient had recurrence after 6 months of T3 and underwent total laryngectomy and selective cervical Lymph node dissection;2 cases of T1b recurred 8 months after surgery and underwent partial laryngectomy and selective cervical dissection;2 cases of T2 recurrent underwent partial laryngectomy in October;currently 77 patients survived well.Throat function retention rate 92.3%(72/78);The Tis recurrence rate was 0(0/24);the recurrence rate of T1a0(0/21);the recurrence rate of T1b was 15.4%(2/13);the recurrence rate of T2 was 18.2%(2/11);the recurrence rate of T3 was 22.2%(2/9).The total recurrence rate was 7.69%(6/78).Conclusion CO_(2) laser microsurgery under oral laryngoscope is the first choice for the treatment of early glottic laryngeal cancer.The surgical trauma is small,the postoperative recovery is fast,the laryngeal function is well preserved,and the long-term survival rate is high.Glottic T2,T3 laryngeal cancer also has a good clinical effect.