窄带成像技术辅助CO_(2)激光手术治疗早期声门型喉癌的疗效分析  

The effect of narrow band imaging in CO_(2)laser therapy in early-stage glottic cancer

作　　者：杜玉晓 杨相立[1] 韩薇薇[1] 刘吉祥[1] DU Yuxiao;YANG Xiangli;HAN Weiwei;LIU Jixiang(Department of Otorhinolaryngology Head and Neck Surgery,Tianjin Union Medical Center,Tianjin,300122,China)

机构地区：[1]天津市人民医院耳鼻咽喉头颈外科,天津300122

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第7期646-650,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨利用窄带成像技术(narrow band imaging,NBI)术前术后辅助显微支撑喉镜下CO_(2)激光手术进行诊治的早期(T1和T2期)声门型喉癌的临床疗效。方法:回顾性分析2011年6月1日至2022年8月31日在天津市人民医院耳鼻咽喉头颈外科接受显微支撑喉镜下CO_(2)激光手术治疗的52例早期声门型喉癌患者资料,应用NBI辅助手术的27例患者为观察组,常规支撑喉镜下CO_(2)激光显微手术的25例患者为对照组,随访时间1~5年,总结分析2组患者术中冰冻病理结果、术后复发率、5年累积无复发生存率、并发症及嗓音恢复情况之间的差别。结果:52例患者均手术顺利,均无需行气管切开术,有1例患者出现声带粘连,但未出现呼吸困难及出血等严重并发症,并发症总发生率为1.92%。观察组5年累积无复发生存率为100%,对照组5年累积无复发生存率为77.90%,2组之间差异有统计学意义(P<0.05)。观察组较对照组的手术切缘更安全,更能准确判断肿瘤黏膜安全切缘(P<0.05)。所有患者进行了嗓音评估,嗓音障碍指数2组之间进行比较,差异无统计学意义(P>0.05)。结论:与常规支撑喉镜下CO_(2)激光显微手术比较,NBI辅助下显微支撑喉镜下CO_(2)激光手术切除早期声门型喉癌术后复发率低,并发症少,可有效提高5年无复发生存率,是一种更安全有效的治疗方法。Objective To explore efficacy of narrow band imaging(NBI)technique in CO_(2)laser therapy in Early-Stage Glottic cancer.Methods The clinical data of patients with Early-Stage Glottic cancer who underwent CO_(2)laser vocal cord resection from June 2011 to August 2022 were retrospectively analyzed.Among these,27 patients who underwent surgery assisted by NBI were assigned to the observation group,while 25 patients who underwent conventional CO_(2)laser microsurgery with a suspension laryngoscope were assigned to the control group.The differences between the two groups were analyzed in terms of intraoperative frozen pathology results,postoperative recurrence rates,5-year cumulative disease-free survival rates,complications,and voice recovery.Results All 52 patients were operated successfully.Temporary tracheostomy and serious complications did not occur during the operation.The postoperative patient's pronunciation was satisfactory.One patient experienced vocal cord adhesion,but there were no severe complications such as breathing difficulties or bleeding,with an overall complication rate of 1.92%.Postoperative follow-up was 1-5 years.The 5 years recurrence free survival in the general group was 77.90%,and the 5 years recurrence free survival in the NBI group was 100%,the difference was statistically significant(P<0.05).NBI endoscopy is safer and more accurate than the general group in determining the safe margin of tumor mucosal resection(P<0.05).Among the patients who accepted the voice analysis,the difference was no statistically significant(P>0.05).Conclusion Compared with conventional CO_(2)laser surgery under microscope,NBI guided laser resection of Early-Stage Glottic cancer is more accurate.NBI guided laser resection could improve 5 years recurrence free survival rate.In a word,narrow-band imaging endoscopy can has very high value in clinical application.

关 键 词：喉肿瘤 二氧化碳激光 显微手术 窄带成像 

分 类 号：R739.65[医药卫生—肿瘤]