CO_2激光喉显微手术治疗声门型癌和声带白斑疗效及对嗓音功能的影响

Effects of CO_2 laser laryngeal microsurgery in the treatment of glottic laryngeal carcinoma and vocal leukoplakia and the effect on vocal function

目的 :探讨CO_2激光喉显微手术治疗声门型癌和声带白斑的效果及嗓音功能恢复情况。方法 :将2012年1月~2015年12月医院收治的声带白斑患者25例和声门型喉癌患者12例作为研究对象,均行CO_2激光喉显微手术治疗,评估短期随访情况及远期疗效,术前及术后1、3、6个月术评估嗓音功能。结果 :25例声带白斑术后3个月电子喉镜检查显示创面愈合良好,声门闭合良好,频闪喉镜显示黏膜波接近正常;随访期间复发率为8.0%。12例声门型喉癌中2例声门闭合良好,1例出现黏膜波;随访期间复发率为16.67%,术前均侵及前联合,均再次手术治疗;3年生存率为91.66%。声带白斑患者术后Jitter、Shimmer、NNE均降低,与术前比较差异有显著性,术后3、6个月组间比较差异无显著性。声门型喉癌患者术后Jitter、Shimmer均降低,与术前相比差异有显著性,且术后不同时间点比较比较差异有显著性;手术后3、6个月NNE降低,与术前、术后1个月比较差异有显著性;声带白斑患者术后Jitter、Shimmer、NNE改善情况优于声门型喉癌患者,差异有显著性。结论 :CO_2激光喉显微手术治疗声带白斑和声门型喉癌T1期效果确切,术后嗓音功能均有不同程度的恢复,恢复情况与手术切除类型密切相关。

Objective To investigate the effects of CO2 laser laryngeal microsurgery in the treatment of glottic laryngeal carcinoma and vocal leukoplakia and recovery of vocal function. Methods From January 2012 to December 2015, 25 cases with vocal leukoplakia and 12 cases with glottic laryngeal carcinoma in the hospital were enrolled in the study. All subjects were treated with CO2 laser laryngeal microsurgery. The short-term follow-up, long-term effect and the vocal function were evaluat-ed. Results 3 months after surgery, the electronic laryngoscopy showed good wound healing and good glottal closure in 25 cases with vocal leukoplakia, and strobolaryngoscope showed near normal mucosal wave. The recurrence rate during follow-up was 8.0% . In 12 cases with glottic laryngeal carcinoma, there were 2 cases with good glottal closure and 1 cases with mucosal wave. The recurrence rate during follow-up was 16.67%. The anterior commissure was invaded before surgery and surgery was car-ried out again. The 3-year survival rate was 91.66%. After surgery, Jitter, Shimmer and NNE in patients with vocal leukoplakia were lower than those before surgery, and there was no significant difference between groups 3 and 6 months after surgery. After surgery, Jitter and Shimmer of patients with glottic laryngeal carcinoma were significantly lower than those before surgery, and there were significant differences between different time points.3 and 6 months after surgery, NNE decreased, and compared with that before surgery and 1 month after surgery, there were significant differences. The improvement of Jitter, Shimmer and NNE in patients with vocal leukoplakia was better than that in patients with glottic laryngeal carcinoma. Conclusion CO2 laser microsurgery is effective in the treatment of vocal leukoplakia and glottic laryngeal carcinoma in T1 phase. After surgery, vocal function recovers to different degrees and the recovery is closely related to the types of surgical resection.