经口CO_(2)激光治疗侵及前连合的早期声门型喉癌22例  

Treatment of early glottic laryngeal carcinoma involving anterior commissure with transoral CO_(2)laser

作　　者：董春光[1] 李利[1] 韩加辉 肖祥[1] 张书嘉[1] DONG Chunguang;LI Li;HAN Jiahui;XIAO Xiang;ZHANG Shujia(Department of Otolaryngology Head and Neck Surgery,the First People’s Hospital of Lianyungang,Lianyungang,Jiangsu,222000,China)

机构地区：[1]连云港市第一人民医院耳鼻咽喉头颈外科,江苏连云港222000

出　　处：《中国耳鼻咽喉头颈外科》2022年第10期613-616,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：连云港市卫生计生委面上科研项目(200807)。

摘　　要：目的探讨侵及前连合的早期声门型喉癌微创切除的方法及疗效。方法对确诊为侵及前连合的早期声门型喉癌22例患者,T1级17例,T2级5例,均为N0级。均行经口支撑喉镜下CO_(2)激光切除,术后随访观察1~5年,并对治疗情况进行分析。结果22例患者手术顺利,术中无严重并发症,术后声音恢复满意,随访1~5年,第1年复发2例,第2年复发1例,第3年复发2例,失访1例。复发后1例再次行激光手术,2例行喉部分切除术,2例行喉全切除术。结论侵犯前连合的早期声门型喉癌,经术前评估未侵犯甲状软骨、排除喉镜下暴露困难的病例,术中通过喉体按压及组织牵拉等暴露手段,扩大切除范围等方法能顺利完成手术,术后定期复查,局部复发后可再次行补救性手术治疗,整体疗效满意。术前评估和术中暴露是能否完成经口微创切除的关键。OBJECTIVE To explore the method and effect of minimally invasive resection of early glottic laryngeal carcinoma involving anterior commissure.METHODS Twenty-two patients with early glottic laryngeal carcinoma invading the anterior commissure were included in this strudy.There were 17 patients with T1 lesions and 5 patients with T2 lesions.All patients were N0 lymph nodes.The lesions were removed with transoral CO_(2) laser surgery.All the patients were followed up for 1 to 5 years.RESULTS All 22 patients were operated successfully,no serious complications occurred during the operation.The postoperative patient's pronunciation was satisfactory.Postoperative follow-up was 1-5 years,2 cases recurred within 1 year,1 case recurred within 2 years,2 cases recurred within 3 years,and 1 case was lost to follow-up.After recurrence,1 case underwent CO_(2) laser surgery again,2 cases underwent partial laryngectomy and 2 cases underwent total laryngectomy.CONCLUSION Early glottic laryngeal carcinoma involving anterior commissure can be successfully operated after adequate preoperative evaluation to exclude the patients' with thyroid cartilage invaded and difficult exposure under suspended laryngoscopy.After local recurrence,salvage surgery can be performed again and can get good results.Preoperative evaluation and intraoperative exposure skills are the key to completely removed the lesions with minimally invasive surgery.

关 键 词：喉肿瘤 治疗结果 前连合 微创手术 CO_(2)激光 

分 类 号：R739.65[医药卫生—肿瘤]