低温等离子射频消融手术治疗早期喉癌疗效观察

Therapeutic effect of low-temperature radiofrequency coblation on early-stage laryngeal cancer

目的:探讨低温等离子射频消融手术治疗早期喉癌(Tis、T_1和T_2)的安全性、有效性及预后。方法:回顾性分析202例经直达喉镜下低温等离子射频消融手术治疗早期喉癌患者的临床资料,其中Tis期34例(16.83%),T_(1a)N_0M_0期49例(24.26%),T_(1b)N_0M_0期50例(24.75%),T_2N_0M_0期69例(34.16%)。对手术患者进行术后严密随访,随访6～60个月,中位随访时间29个月。结果:202例患者中,165例(81.68%)未见复发,均获得了良好的手术效果,均未出现术后出血、呼吸困难等严重并发症;37例(18.32%)术后复发,其中Tis期1例(0.50%),T_(1a)期7例(3.47%),T_(1b)期7例(3.47%),T_2期22例(10.89%)。复发患者中13例行全喉切除术(其中5例复发进展为T_3期,8例进展为T_4期),分别为T_(1a)期1例、T_(1b)期2例、T_2期10例;4例行垂直半喉切除手术,分别为T_(1a)期3例、T_2期1例;5例再次行等离子射频消融手术,分别为T_(1b)期3例、T_2期2例,后均未再次复发;1例患者喉部未见明显复发但颈部淋巴结转移,遂行单纯颈淋巴结清扫术;1例T_2期患者复发后为解除喉阻塞单纯行气管切开术,后未进一步治疗;3例患者复发后行放化疗好转;死亡9例,其中行放化疗后死亡5例,复发后放弃治疗4例。结论:低温等离子射频消融手术治疗早期喉癌患者在术后保留喉功能、减少手术创伤方面较喉癌传统手术具有较大的优势,并可以获得较为满意的疗效,但在部分T_2期患者的手术适应证选择上仍需慎重。

Objective:To evaluate the safety,efficacy and prognosis of low-temperature plasma radiofrequency coblation for early-stage laryngeal cancer(Tis,T1and T2).Method:A retrospective analysis of 202 patients with early-stage laryngeal cancer who underwent the low-temperature radiofrequency coblation surgery,including 34 cases of Tis(16.83%),49 cases of stage T1aN0 M0(24.26%),50 cases of stage T1bN0 M0(24.75%)and 69 cases of stage T2 N0 M0(34.16%).Surgical patients were followed up closely for 6 to 60 months,with a median follow-up of 29 months.Result:Of the 202 patients,165(81.68%)had no recurrence and achieved good surgical results.None of them suffered severe complications such as post-operative hemorrhage and asphyxia.37 cases(18.32%)had recurrence,including 1 case(0.50%)in stage Tis,7 cases(3.47%)in stage T1a,7 cases(3.47%)in stage T1b,and 22 cases(10.89%)in stage T2.Thirteen patients who had recurrence underwent total laryngectomy(5 of which had a recurrence of T3 and 8 of which progressed to T4),including 1 in the stage T1a,2 in the stage T1b,and 10 in the stage T2.Vertical hemilaryngectomy were performed in 4 cases,3 cases of stage T1aand 1 case of stage T2;5 cases underwent plasma radiofrequency coblation again,including 3 cases of stage T1band 2 cases of stage T2,no recurrence was found in all the patients;1 patient had no obvious recurrence in the larynx but had cervical lymph node metastasis,radical neck dissection was performed;1 patient with stage T2 recurrence was treated with a tracheotomy to relieve laryngeal obstruction without further treatment;3 cases showed improvement by radiotherapy and chemotherapy treatment after recurrence;9 death cases,5 patients died after radiotherapy and chemotherapy,and 4 patients stopped getting treatment after recurrence.Conclusion:Low-temperature radiofrequency coblation surgery for patients with early-stage laryngeal cancer has great advantages in the preservation of laryngeal function and reduction of surgical trauma after surgery compared with traditional surgical method,and can obtain satisfactory results,but the selection of surgical indications for some patients with clinical stage T2 is still need to be carefully considered.