CO2激光手术治疗喉癌的并发症分析  

Complications of CO2 laser surgery in the treatment of laryngeal carcinoma

作　　者：吴娇娇[1] 黄志刚[1] 房居高[1] 陈学军[1] 周维国[1] 于振坤[1] 黄俊伟[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科教育部耳鼻咽喉头颈科学实验室,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2011年第2期118-122,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：基金项目：北京市卫生系统高层次卫生技术人才培养计划（2009-3-30）

摘　　要：目的总结CO2激光手术治疗喉癌的并发症发生情况，分析影响并发症发生的相关因素，并提出相应的预防措施。方法总结分析北京同仁医院耳鼻咽喉头颈外科1992年8月至2008年12月激光手术治疗的912例喉癌患者临床资料。声门上型喉癌35例，声门型喉癌877例，声门型喉癌中原位癌（Tis）53例，T1659例，T2158例，T37例。术后随访2～18年，中位随访时间9．3年。结果912例患者中，824例存活，失访29例（按死亡计算），死亡59例。直接法统计总的局部复发率为9．4％（86／912），3年生存率95．6％（775／811），5年生存率87．9％（518／589）。83例（9．1％）出现手术相关并发症，其中声门上型喉癌中并发症发生率17．1％（6／35），声门型喉癌8．8％（77／877），两组差异无统计学意义（X2=2．85，P〉0．05）。声门型喉癌中，原位癌并发症发生率为5．7％（3／53），T1为7．8％（51／659），1、2为13．3％（21／158），T3为28．6％（2／7），组间差异有统计学意义（x2=8．97，P〈0．05）。病变侵犯前联合的并发症发生率为12．8％（31／242），未侵犯前联合为7．2％（46／635），组间差异有统计学意义（x2=6．78，P〈0．05）。II型手术患者并发症发生率为3．8％（4／105），Ⅲ型为7．0％（20／287），Ⅳ型为9．7％（22／226），V型为12．0％（31／259），组间差异有统计学意义（x2=7．96，P〈0．05）。结论全麻下显微喉镜激光手术治疗喉癌在术中、术后存在潜在风险和并发症，并发症的发生与原发肿瘤的部位范围和手术切除的范围和深度有关，需要采取积极的预防措施。Objective To evaluate the complications of CO2 laser surgery in the treatment of laryngeal carcinoma, to analyze related factors and to propose preventive measures. Methods Retrospective analysis of 912 cases of laryngeal carcinoma（35 cases of supraglottic cancer and 877 cases of glottic cancer） treated only with laser surgery in Tongren Hospital was carried out. Among the glottic cancer, carcinoma in situ （Tis）, T1, 32 and T3 were 53, 659,158 and 7 cases. The follow-up period ranged from 2 to 18 years, with a median follow-up time of 9. 3 years. Results Of 912 cases, 824 cases were still alive, 29 cases failed to be followed-up（taken into dead number）, and 59 cases were dead. The recurrent rate was 9.4% （86/912）. Three year survival rate was 95.6% （775/811）and five year survival rate was 87.9% （518/589）. The incidence of surgery complications was 9. 1% （83/912）. Incidence of complications in supraglottic carcinoma and glottic carcinoma were 17. 1% （6/35） and 8. 8% （77/877）, respectively, with no difference between the two groups （ x2 = 2. 85, P 〉 0.05）. Incidence of complications of Tis, T1, T2 and T3 cases of glottic cancer were 5.7% （3/53）, 7.8% （51/659）, 13.3% （21/158） and 28.6% （2/7） respectively, with significant difference （ X2 = 8.97, P 〈 0. 05 ） . Incidence of complications of glottic carcinoma with and without anterior commissure indision were 12. 8% （ 31/242 ） and 7.2% （ 46/635 ） respectively, with significant difference between the two groups （ X2 = 6. 78, P 〈 0. 05 ）. Incidence of complications in the patients underwent type Ⅱ,Ⅲ,Ⅳ,Ⅴ cordectomy were 3.8% （4/105）, 7.0% （20/287）, 9. 7 % （22/226） and 12. 0% （31/259） respectively, with significant difference （x2 = 7.96, P 〈 0. 05）. Conclusions There are some potential risks and complications intra- and post-operatively, according to the sites and extent of the primary tumors and the range and depth of removed tissues. It needsto take active preventi

关 键 词：喉肿瘤 激光疗法 手术中并发症 手术后并发症 

分 类 号：R739.65[医药卫生—肿瘤]