甲状软骨楔形切除在累及前联合T1T2期声门型喉癌手术中的应用

Efficacy analysis of wedge resection of the thyroid cartilage in patients with anteriorly invasive T1T2 glottic laryngeal cancer

目的探讨甲状软骨楔形切除在累及前联合T1T2期声门型喉癌手术中应用的疗效。方法选取2015年1月至2021年1月梅州市人民医院收治的60例累及前联合、声门下、喉室以及浸润生长为主的T1T2期声门型喉癌患者,按随机数字表法分为观察组及对照组(每组30例),观察组30例患者在暴露好甲状软骨与环状软骨后,作环甲膜切开,鼻内镜辅助下查清癌肿范围,在甲状软骨外侧面作好楔形切除范围的标记,在喉裂开的同时作甲状软骨楔形切除,在安全边缘将癌肿彻底切除,取切缘组织送冰冻活检未见癌后进行喉功能重建。对照组30例患者按照常规喉裂开声带癌切除方法治疗,术后进行随访观察,比较分析两组患者术后的嗓音质量、并发症的发生率、拔管率、复发率以及生存率。结果至随访结束,观察组的复发率为6.7%,低于对照组的26.7%,两组复发率比较,差异有统计学意义(P<0.05),两组拔管率、生存率比较,差异无统计学意义(P>0.05);术后并发症方面,观察组总的并发症发生率为23.33%,低于对照组的53.33%,两组总并发症比较,差异有统计学意义(P<0.05)。术后半年嗓音稳定期,观察组VHI-10评分为(5.83±2.829)分,低于对照组(24.33±4.936)分,差异有统计学意义(P<0.05)。结论在累及前联合、声门下、喉室以及浸润生长为主的T1T2期声门型喉癌手术中应用甲状软骨楔形切除进行喉功能重建有利于嗓音功能恢复,并发症少,局部复发率低。

Objective To evaluate the efficacy of wedge resection of the thyroid cartilage in surgical management of anteriorly invasive T1T2 glottic laryngeal cancer.Methods This study included 60 patients diagnosed with T1T2 glottic laryngeal cancer,primarily exhibiting anterior invasion,subglottic extension,and infiltrative growth,treated at Meizhou People′s Hospital from January 2015 to January 2021.Patients were randomly assigned to two groups:the observation group(30 patients)underwent conventional laryngotomy,with cancer extent assessed,followed by wedge resection of the thyroid cartilage,ensuring complete tumor excision at a safe margin.Frozen section analysis of the margin showed no cancer before performing laryngeal function reconstruction.The control group(30 patients)received standard laryngotomy and vocal cord cancer excision.Postoperative follow-up was conducted to compare and analyze voice quality,complication rates,extubation rates,recurrence rates,and survival rates between the two groups.Results At the end of the follow-up period,there was a statistically significant difference in recurrence rates between the two groups(6.7%vs.26.7%,P<0.05).No significant differences were observed in extubation rates and survival rates(P>0.05).The total complication rate was significantly different between the two groups(23.33%vs.53.33%P<0.05).At six months postoperative,the Voice Handicap Index-10(VHI-10)score was significantly higher in the control group compared to the observation group(5.83±2.829 vs.24.33±4.936,P<0.05).Conclusion The application of wedge resection of the thyroid cartilage in surgeries for anteriorly invasive,subglottic,and infiltrative T1T2 glottic laryngeal cancer is beneficial for restoring vocal function,associated with fewer complications and lower local recurrence rates.This technique represents a feasible and effective treatment option for early-stage glottic laryngeal cancer.