CO_(2)激光联合干扰素治疗喉乳头状瘤的临床疗效和复发的影响因素分析  

Analysis on Clinical Efficacy to Treat Laryngeal Papilloma with CO2 laser and interferon & Recurrence Factors

作　　者：张仕林 史欣 张冀琳 陈进伟 樊丽娜 王玮 蒋源 孙继周 汪立[2] 张柯 ZHANG Shilin;SHI Xin;ZHANG Jilin;CHEN Jinwei;FAN Lina;WANG Wei;JIANG Yuan;SUN Jizhou;WANG Li;ZHANG Ke(Department of Otorhinolaryngology Head and Neck Surgery,Xidian Group Hospital,Xi'an 710077,China;Department of Otorhinolaryngology Head and Neck Surgery,the Second Affiliated Hospital of Xi'an Jjaotong Universily)

机构地区：[1]西电集团医院耳鼻咽喉头颈外科,西安市710077 [2]西安交通大学第二附属医院耳鼻咽喉头颈外科

出　　处：《中国激光医学杂志》2022年第2期95-100,共6页Chinese Journal of Laser Medicine & Surgery

摘　　要：目的分析CO_(2)激光联合干扰素治疗喉乳头状瘤的临床疗效和复发的影响因素。方法回顾性分析2019年2月至2020年2月,喉乳头状瘤患者126例的临床资料,均采用CO_(2)激光联合干扰素治疗,激光治疗功率2~5 W,脉冲模式0.1 s,光斑大小0.1 mm,记录手术时间、术中出血量。激光治疗后3个月评估疗效和并发症,随访12个月记录复发率,同时根据患者复发情况分为两组,即复发组(n=13),未复发组(n=113),运用二元Logistic回归分析影响患者复发的独立因素,再用Spearman法分析,复发率与独立影响因素的相关性。结果126例患者接受治疗后,平均手术时间(45.7±5.1)min;术中出血量10~20 mL,平均(15±4.5)mL,总有效率95.2%(120/126),共有9例出现并发症。经12个月随访,共有13例出现复发,平均复发时间(10.1±0.3)个月。经二元Logistic回归分析,手术延迟、喉梗阻Ⅳ级、手术次数≥2次、存在声带粘连、切割深度超过黏膜下层是导致患者复发的独立影响因素。经Spearman法分析,复发率与核分裂象数、手术次数、手术时机、喉梗阻分级、声带粘连、切割深度呈正相关性(P<0.05)。结论CO_(2)激光联合干扰素治疗喉乳头状瘤效果显著,但术后可受到切割深度、手术次数、手术时机、喉梗阻分级、声带粘连等因素影响,出现复发。Objective To analyze the clinical efficacy to treat laryngeal papilloma jointly with COlaser and interferon and the recurrence factors.Methods The clinical data of 126 patients of laryngeal papilloma treated during the period from Feb.2019 to Feb.2020 were analyzed retrospectively.The operation time and intraoperative bleeding of the patients treated jointly with COlaser and interferon were analyzed.The curative effect and complications were evaluated 3 months after the laser treatment,and the recurrence rate was recorded during the 12 months’ follow-up.At the same time,the patients were divided into two groups according to recurrence situations:the recurrence group(n=13)and non-recurrence group(n=113).The independent factors affecting the recurrence were analyzed via binary logistic regression,and the correlation between the recurrence rate and the independent factors was analyzed with Spearman method.Results As for the 126 patients given the treatment,the average operation time was(45.7±5.1)min,the average intraoperative blood loss(15±4.5)m L,and the total effective rate 95.2%(120/126).Totally 9 patient had complications.It is observed during the 12 months’ follow-up that recurrence occurred to 13 patients in total,and the average recurrence time was(10.1±0.3)months.It is found via binary logistic regression analysis that delay of operation,Laryngeal obstruction Ⅳ,number of operations ≥2 times,presence of vocal cord adhesions and cutting depth beyond the submucosa were independent influencing factors that led to the recurrence.According to the analysis results of Spearman method,the recurrence rate was positively correlated with the number of mitotic figures,number of operations,timing of operation,laryngeal obstruction grade,vocal cord adhesion and depth of cut(P<0.05).Conclusions COlaser combined with interferon is effective in treating laryngeal papilloma,but recurrence may be affected by cutting depth,operation times,operation time,laryngeal obstruction grade,vocal cord adhesion and other factors

关 键 词：激光 喉乳头状瘤 复发 影响因素 

分 类 号：R616.4[医药卫生—外科学] R767.1[医药卫生—临床医学]