经口激光喉显微手术治疗早期声门型喉癌的疗效分析  

Results of transoral laser microsurgery for early glottic carcinoma

作　　者：周梁[1] 吴海涛[1] 陈小玲[1] 李筱明[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2016年第4期248-250,254,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：上海市市级医院适宜技术联合开发推广应用项目(SHDC12012202);上海市市级医院新兴前沿技术项目(SHDC12015114)

摘　　要：目的 分析经口激光喉显微手术治疗声门型喉癌的疗效,并探讨其手术适应证和手术要点。方法回顾分析本院2010年6月~2013年12月应用CO2激光治疗84例声门型喉癌（T1期82例和T2期2例）的疗效。结果 术后随访中,75例无瘤生存,9例复发,其中局部复发8例,1例发生颈淋巴结转移。除1例肿瘤复发死亡外,其他病例均经再次挽救手术后无瘤生存。以Kaplan-Maier法计算生存率,3年和5年局部控制率均为90.5%,3年和5年生存率均为98.8%。所有病例术后声音嘶哑都比较明显,随着患侧声带切除后的逐渐修复,发音逐渐响亮,1年左右接近正常发音或仅有轻度嘶哑。术后无气管切开,无误吸和呼吸困难发生,无严重并发症。结论 经口激光显微手术创伤小、出血少、恢复快、疗效肯定,且能保留较为满意的发音功能,是治疗早期声门型喉癌的理想方法。掌握适当的适应证、良好的暴露及熟练的手术技巧是手术成功的关键。（中国眼耳鼻喉科杂志,2016,16：248-250,254）Objective To evaluate the oncological results of transoral laser microsurgery（TLM） in the treatment of early glottie carcinoma. Methods Eighty four eases of glottic carcinoma （T1 = 82 ,T2 = 2）operated with TLM between 2010 and 2013 were retrospectively analyzed. Results Among 84 eases of glottie carcinoma, 75 eases were followed up postoperatively from 2 to 5 years without recurrence. Nine recurrences occurred in which 8 were local recurrences, while one had cervical lymph nodes metastasis. Except one patient died of recurrence, salvage surgeries with partial or total laryngectomy or neck dissection were performed for 8 recurred patients. Then the patients were followed up till now without recurrence. One ease was lost during the follow up. Three-year and five-year local control rates were 90.5%, while three-year and five-year overall survival rates were 98. 8%. All patients had remarkable hoarseness after the surgery. Their voice improved progressively during the postoperative natural repair. One year after the surgery, most of the patients had a near normal voice or only had a mild hoarseness. None of the patients had tracheotomy during and after the operation. No aspiration occurred. Except mild adhesion of anterior commission occurred in 12 eases with anterior commission involvement by the tumors, no other complications occur-red in this series. Conchtsions TLM is a minimally invasive, effective and safe procedure for early glottic carcinoma. Satisfactory exposure, good surgical skill and appropriate surgical indications are fundamental for the success of treatment.

关 键 词：喉肿瘤 声门 癌 鳞状细胞 激光手术 

分 类 号：R739.65[医药卫生—肿瘤]