支撑喉镜下CO2激光辅助声带囊肿显微切除术疗效分析  

Clinical analysis of COs-laser assisted suspension laryngoscopic surgery for vocal fold cyst

作　　者：关中[1] 梁发雅[1] 许耀东[1] 杨金珊[1] 张雪媛[1] 

机构地区：[1]中山大学孙逸仙纪念医院耳鼻咽喉头颈外科,广州510120

出　　处：《中华显微外科杂志》2015年第5期438-442,共5页Chinese Journal of Microsurgery

基　　金：国家自然科学基金项目（30873009）

摘　　要：目的 比较支撑喉镜下CO2激光辅助声带囊肿显微切除和支撑喉镜下冷器械显微切除的疗效.方法 2011年1月至2014年12月,频闪喉镜确诊为声带囊肿且行手术切除的患者72例,随机分为CO2激光辅助组36例及冷器械组36例,术前及术后1、3个月行动态喉镜检查及嗓音质量主、客观评估. 结果 所有患者均顺利完成手术.采用CO2激光辅助手术完整剥离囊肿成功率（29/36,80.5％）高于冷器械组（21/36,58.3％）,其中左侧声带囊肿采用CO2激光辅助手术完整剥离囊肿成功率（13/16,81.3％）高于冷器械手术（9/19,47.4％）,右侧声带表皮样囊肿完整剥离成功率（17/19,89.4％）高于潴留囊肿（11/18,61.1％）,差异均有统计学意义（P＜ 0.05）.3个月内复发的病例分别是0例（0/36,0％）和2例（2/36,5.6％）,经x2检验,差异无统计学意义（P＞0.05）.相关因素分析表明,囊肿复发与囊肿是否完整剥离有关,与手术方式、囊肿性质及囊肿位置无关.两组患者术前及术后1、3个月嗓音主观及客观指标经秩和检验,差异均无统计学意义（P＞0.05）. 结论 支撑喉镜下CO2激光辅助声带囊肿显微切除能增加手术的精准度,减少左手操作对手术质量的影响,提高囊肿完整剥离的成功率,降低复发率.Objective To compare the clinical effect between CO2-1aser assisted and cold instrument assisted suspension laryngoscopic surgery for vocal fold cyst.Methods From January, 2011 to December, 2014, 72 patients with vocal fold cyst, which diagnosed by strobolaryngoscopy, were randomly divided into CO2-1aser assisted group and cold instrument group.Strobolaryngoscopy, acoustic analysis and perceptual voice analyses were performed on each patient before surgery, 1 month, and 3 months after surgery, respectively.Results All operations were successfully completed.The complete vocal fold cyst resection rate of CO2-1aser assisted group was significantly higher than cold instrument group （29/36, 80.5％ vs 21/36, 58.3％, P ＜ 0.05）, especially the left vocal fold cyst （13/16, 81.3％ vs 9/19, 47.4％, P ＜ 0.05）.The complete right vocal fold epidermoid cyst resection rate was significantly higher than retention cyst （17/19, 89.4％ vs 11/18, 61.1％, P ＜ 0.05）.Two recurrent cases were found in cold instrument group but no recurrent cases in CO2-laser assisted group （0/36, 0％ vs 2/36, 5.6％, P ＞ 0.05）.Correlation analysis showed that vocal fold cyst recurrence was related to complete resection rate and has no relation with surgical methods, histopathological types and position.Subjective and objective assessment of voice quality in preoperative, 1-month postoperative and 3-month postoperative were similer between CO2-1aser assisted group and cold instrument group （P ＞ 0.05）.Conclusion The CO2-laser assisted suspension laryngoscopic surgery for vocal fold cyst, can increase the surgical precision, reduce the left hand impact, improve the complete resection rate and reduce the recurrence rate.

关 键 词：声带囊肿 CO2激光 显微外科手术 疗效分析 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]