CO_2激光治疗T_(is)-T_1声门型喉癌术后嗓音康复的客观评价  

Objective evaluation of CO_2 laser in the treatment of T_(is)-T_1 glottic carcinomaafter operation for voice rehabilitation

作　　者：王惠忠[1] 孙丰林[1] 满荣军[1] 耿阳[1] 王孝[1] 王海鹏[1] 高丽[1] 许荣[1] 夏拥军[1] 

机构地区：[1]山东省淄博市中心医院耳鼻咽喉头颈外科,山东淄博255031

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第24期1979-1982,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：山东省淄博市科技局项目(No:GG011223)

摘　　要：目的:采用声学参数客观评价CO2激光治疗Tis-T1声门型喉癌术后不同时期的嗓音康复状况。方法:CO2激光治疗早期声门型喉癌41例,其中Tis23例(Tis组),T1N0M018例(T1组)。术中CO2激光切除病变的范围根据肿瘤的不同分期而定,通过术中冷冻病理检查保证手术切缘阴性。对30例健康中老年男性(正常组)及41例患者的手术前后不同时期(术前1天、术后3个月、6个月及1年)行嗓音声学检测(包括基频、基频微扰、振幅微扰、声门噪声能量及最长声时),比较评价术后不同时期嗓音康复情况。结果:术后病理结果示,23例为鳞状上皮重度不典型增生,16例为高分化鳞状细胞癌,2例为中分化鳞状细胞癌。3例患者术中出现腭舌弓黏膜撕裂,所有患者均未出现呼吸困难,并在术后3d恢复正常进食。全部患者随访满1年,均未复发。Tis组和T1组患者术后不同时期的基频、基频微扰、振幅微扰比较差异均有统计学意义(P<0.05),而声门噪声能量及最长声时在术后6个月及1年时的差异无统计学意义(P>0.05)。结论:CO2激光治疗早期声门型喉癌疗效确切,患者术后嗓音功能较术前有不同程度改善,嗓音质量随康复时间的推移逐渐好转,部分反映嗓音功能的客观参数在术后半年之后逐渐趋于稳定。Objective： To objectively evaluate the voice rehabilitation status in different period after treatment of Tis-T1 glottic carcinoma by CO2 laser with voice parameters. Method： A retrospective review of 41 cases with Tis-T1 glottic carcinoma treated by CO2 laser was performed, 23 cases were stage Tis （Tis group） and 18 cases with stage T1 N0M0 （T1 group）. The range of excision of the lesion by CO2 laser was according to the different sta- ges of the tumor, and ensured theoperation negative margin was by intraoperative frozen pathological examination. We tested and compared the actual voice （containe F0 ,Jitter,Shimmer,NNE and MPT） of 30 cases of healthy mid- dle-aged and old male（normal group） and all the patients at one day prior to operation, three months, six months and one year after operation respectively, which was to evaluate the voice rehabilitation status in different period after operation objectively. Result： Postoperative pathological examination revealed, 23 cases were squamous epi- thelium severe atypical hyperplasia, 16 cases were well differentiated squamous cell carcinoma, and 2 cases were moderately differentiated squamous cell carcinoma. Palatoglossal arch mucosal tear occurred in 3 patients. Respir- atory difficulties were not seen in all cases, and normal oral feeding was obtained in all cases in postoperative three days. All patients were followed up for one year. There was statistical significance in F0, Jitter, Shimmer of both Tis group and T1 group after operation in different periods（P〈0.05）. But there was no statistical significance in NNE and MPT between six months and one years after operation in the two groups（P〉0.05）. Conclusion：CO2 la- ser surgery is an effective treatment for early glottic carcinoma. Postoperative vocal function was improved in var- ying degrees, and voice quality gradually improved with the rehabilitation time. Partly objective parameters reflec- ting the vocal function gradually stabilized after half a year after operation. Key

关 键 词：喉肿瘤 激光疗法 嗓音 声学分析 生活质量 

分 类 号：R739.65[医药卫生—肿瘤]