CO_2激光喉显微手术治疗喉癌前病变疗效观察及相关因素探讨  

Efficacy of CO_2 laser in the treatment of precancerous laryngeal lesions under phonomicrosurgery and its relative factors

作　　者：古庆家[1] 冯勇[1] 余晓旭[1] 樊建刚[1] 李德炳[1] 何刚[1] 

机构地区：[1]四川省人民医院耳鼻咽喉科,成都610072

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第15期1142-1144,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：四川省人民医院高新技术资助项目(No:09-075)

摘　　要：目的：探讨CO2激光喉显微手术治疗喉癌前病变的疗效和安全性。方法：在显微支撑喉镜下,对63例喉癌前病变患者采用CO2激光进行黏膜表皮剥脱术或黏膜下切除术治疗,其中声带白斑24例;轻度异性增生15例;中、重度异性增生16例;喉乳头状瘤8例。结果：全部患者行CO2激光手术治疗后均成功,随访6~39个月,全部患者存活。本组3例均及时发现复发或癌变,其中2例喉乳头状瘤于术后1年复发,再次行CO2激光喉显微手术切除,1例重度不典型增生者术后1.5年癌变,行喉垂直部分切除并术后放疗,至末次随访局部均未再复发。术后无一例患者出现呼吸困难、出血等严重并发症。结论：CO2激光喉显微手术是治疗喉癌前病变的有效方法,通过选择合适的患者并注意术中操作,可减少或避免显微喉镜激光手术引起的声带粘连。Objective：To investigate the efficacy of CO2laser treatment for patients with precancerous laryngeal lesions under phonomicrosurgery and to explore the points for attention in operation.Method：They were all treated with phonomicrosurgery techniques as mucosal epitheliumablation or mucosal stripping by using CO2laser.Eight patients with laryngeal papilloma were excised by CO2laser.Result：All patients were treated with CO2laser surgery successfully.During follow-up of 6to 39months,all patients survived.Local recurrence or canceration were detected in 3cases,of which 2cases with laryngeal papilloma underwent CO2laser treatment in one year postoperatively,while the other case with severe dysplasia underwent laryngeal vertical partial laryngectomy and postoperative radiotherapy one and half year postoperatively due to canceration.No local recurrence occurred until the last follow up.No severe complications such as dyspnea and hemorrhage occured.Conclusion：CO2laser surgery is an effective and minimally invasive treatment for precancerous laryngeal lesions.Through selecting the appropriate patient and paying attention to the operation during surgery,the adhesion of vocal cord can be reduced or even be avoided after CO2laser surgery.

关 键 词：显微外科手术 喉肿瘤 CO2激光 

分 类 号：R767.1[医药卫生—耳鼻咽喉科]