声门型喉癌CO_2激光显微手术治疗局部复发与前联合受侵犯对比分析

Comparative analysis of CO_2 laser microsurgery for the treatment of glottic carcinoma with local recurrence

目的研究分析CO_2激光手术治疗声门型喉癌的临床疗效,并对其局部复发与前联合受侵犯的相关性进行探讨,以期为临床诊治提供理论依据。方法入选2010年1月至2015年12月于徐州医科大学附属淮安医院就诊,并进行手术的声门型喉癌患者78例作为研究对象,按手术方法不同分为观察组48例和对照组30例,观察组予CO_2激光手术治疗,对照组予传统喉裂开切除治疗,针对两组患者手术效果进行对比分析;观察组根据前联合受累情况分为前联合受累组18例和前联合未受累组30例,对照组前联合受累组12例和前联合未受累组18例,术后随访1年,比较两组患者局部复发情况。结果不同手术方法的两组患者嗓音学分析和电声门图各项参数进行比较分析,结果显示观察组在嗓音学分析和电声门图各项参数与对照组患者比较,差异具有统计学意义,观察组术后嗓音恢复较好(P<0.05);观察组不良反应发生率为2.08%,明显低于对照组(23.3%),差异具有统计学意义(P<0.05);前联合受累患者局部复发率为33.3%,明显高于前联合未受累组(6.7%),差异有统计学意义(P<0.05)。结论 CO_2激光手术治疗早期声门型喉癌手术创伤小、并发症较少、术后嗓音恢复较好;前联合受累的早期声门型喉癌CO_2激光仍可作为主要手术方式,但必须把握好分期,对T2以上分期患者须谨慎,术前要充分研判病变范围等,以降低复发率。

Objective To investigate the clinical efficacy of CO_2 laser surgery in the treatment of patients with laryngeal cancer, and to explore the correlation of local recurrence and anterior combined with the invasion, in order to provide theoretical basis for clinical diagnosis and treatment. Methods From January 2010 to December 2015 in our hospital for surgery with glottic carcinoma, 78 cases as the research object, according to the different surgical methods were divided into observation group 48 cases and control group 30 cases, the observation group was treated with CO_2 laser treatment, the control group was treated with traditional laryng of issues resection, compared two groups; the observation group according to the former joint involvement were divided into former joint involvement group 18 cases and without involvement 30 cases, control group were divided into 12 cases as the joint involvement group and 18 cases without involvement, all were followed up for 1 year, compared the local recurrence of two groups. Results Voice science analysis and electroglottographic parameters were compared and analyzed in different surgical methods of two groups. The incidence of adverse reactions in the observation group was 2.08%, significantly lower than the control group(P<0.05). Local recurrence rate was 33.3% in joint involvement patients, was obviously higher than that without involvement patients 6.7%, the difference was significant(P<0.05). Conclusions CO_2 laser surgery for early glottic carcinoma surgical trauma, has less complications and better postoperative recovery of voice; the joint involvement of early glottic carcinoma can be used CO_2 laser as main operation modes, but must grasp the staging, T2 patients should be careful before surgery to fully judge the extent, to reduce the recurrence rate.