支撑喉镜下鼻内镜辅助激光治疗早期声门型喉癌13例报告  

Laser surgery for early-stage glottic carcinoma under self-retaining laryngoscope with nasal endoscopic assistance

作　　者：黄益灯 夏思文 孙广滨[2] 麻琼钒 周水淼[3] 郑宏良[3] 

机构地区：[1]解放军第118医院耳鼻咽喉科,浙江温州325000 [2]上海市浦东新区公利医院耳鼻咽喉科 [3]上海长海医院耳鼻咽喉科

出　　处：《解放军医学杂志》2009年第6期780-782,共3页Medical Journal of Chinese People's Liberation Army

基　　金：南京军区卫生专业人才培养122工程基金资助项目(卫计2007038)

摘　　要：目的探讨支撑喉镜下鼻内镜辅助激光治疗早期声门型喉癌的疗效。方法回顾性分析1999年6月-2003年3月早期声门型喉癌13例,其中TisN0M02例、T1aN0M07例、T1bN0M03例、T2N0M01例,全麻支撑喉镜声门暴露不佳,导入不同角度的鼻内镜,清楚暴露肿瘤后使用Nd:YAG激光、Diomed激光沿肿瘤边缘汽化或切割,完整切除肿瘤。结果随访3～5年,局部复发2例,1例为T1b患者,1例为T2患者。复发患者1例行局麻电子喉镜下Nd:YAG激光肿瘤切除术,1例行垂直半喉切除术。13例患者随访3年,生存率100%(13/13);随访5年,1例失访(按死亡计算),生存率为92.3%(12/13)。结论支撑喉镜配合鼻内镜下激光治疗早期声门型喉癌具有视野清晰、病变暴露好、操作准确、创伤小、恢复快、喉功能保存好、可避免气管切开及喉裂开等优点。Objective To assess the feasibility and curative effects of laser surgery in treatment of early-stage glottic carcinoma under self-retaining laryngoscope with nasal endoscopic assistance. Methods Thirteen cases of glottic carcinoma （Tis N0 M0 ： 2 eases; T1a N0 M0 ： 7 cases; T1b N0 M0 ： 3 cases; T2 N0 M0 ： 1 case） extirpated with Nd： YAG laser or Diomed laser from June 1999 to March 2003 were retrospectively analyzed. Because of the poor glottie exposure with self-retaining laryngoscope under general anesthesia, various angular nasal endoscopes were used. The tumor was distinctly displayed on monitor screen with nasal endoscopic assistance and were completely removed through vapourization or removed with Nd：YAG laser or Diomed laser. Results The follow-up period was three to five years. Two patients were found to have local recurrence. One patient received treatment with Nd：YAG laser surgery under electronic laryngoscope with local and superfacial anesthesia, and the patient was followed up for three years without showing recurrence. The other patient underwent vertical hemilaryngectomy and was followed up for three and half years without showing recurrence. All 13 cases were followed up for three years, and all of them were alive. Three-year survival rate was 100% （13/13）. When they were followed up for five years, one patient lost track （counted as death）, therefore the five-year survival rate was 92.3% （12/13）. Conclusions With the assistance of various angular nasal endoscope, the glottic tumors can be exposed distinctly under self-retaining laryngoscope and removed completely. Nd： YAG laser or Diomed laser is an effective and safe procedure with minimal invasion for the treatment of early-stage glottic carcinoma. The advantages of this technique include lower complication rate and high rate of preservation of laryngeal functions, avoidance of tracheotomy and the sequela of laryngeal fissure.

关 键 词：喉肿瘤 激光手术 鼻内镜 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]