喉癌内镜CO_(2)激光治疗后预防声带粘连的不同治疗方法疗效对比研究  

A comparative study on the efficacy of different treatment methods for preventing vocal cord adhesion after laser treatment for glottic cancer

作　　者：李昊璞 朱敏辉 李孟 陈世彩 张才云 王伟 高颖娜 陈梦婕 郑宏良 LI Haopu;ZHU Minhui;LI Meng;CHEN Shicai;ZHANG Caiyun;WANG Wei;GAO Yingna;CHEN Mengjie;ZHENG Hongliang(Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Naval Medical University,Shanghai,200433,China)

机构地区：[1]海军军医大学第一附属医院(长海医院)耳鼻咽喉头颈外科,上海200433

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第10期897-902,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:比较累及前联合早期声门型喉癌行CO_(2)激光分期分侧手术、一期手术联合喉模置入以及单纯CO_(2)激光切除3种手术方案的原发灶控制、嗓音功能恢复、术后粘连率及粘连程度。方法:以83例累及前联合的T1-2N0M0期声门型喉鳞状细胞癌接受CO_(2)激光治疗的患者为研究对象,并分为3组:A组15例,采用分侧分期切除术;B组18例,采用一期手术切除联合前联合硅胶喉模置入术;C组50例,采用单纯CO_(2)激光切除术。应用嗓音障碍指数VHI-10、听感知评估GRBAS及最长发声时长(MPT)对患者术前及术后6个月的嗓音功能进行评估,采用Cohen声带粘连分类法评价声带粘连程度。统计各指标术前及术后的差异性,并分析3组原发灶控制率。结果:A、B组各出现局部复发1例,C组局部复发4例,均无远处转移。术后发生不同程度的声带粘连共77例,其中A组粘连发生率73.3%(11/15),B组88.9%(16/18),C组100%(50/50),C组的术后声带粘连率及粘连程度均明显高于A、B组。3组术后患者VHI-10值较术前明显增加(P<0.05),而术后组间比较,C组明显差于A、B组(P<0.05)。C组患者术后MPT较术前明显缩短,且均显著短于A、B组的术后(P<0.05)。C组患者术后的G、R分级均显著高于术前,而且也明显差于A、B组的术后(均P<0.05)。结论:对于累及前联合早期声门型喉癌选择分期手术或一期手术切除联合前联合硅胶喉模置入治疗,在术后声带粘连程度及嗓音功能保护上均明显优于单纯激光肿瘤切除术。Objective Comparing the primary tumor control,vocal function recovery,postoperative adhesion rate and degree of adhesion in early glottic cancer involving the anterior commissure treated with CO_(2)laser staged and lateral surgery,one-stage surgery combined with laryngeal stent placement,and simple CO_(2)laser excision.Methods This study focuses on 83 patients with T1-2N0M0 stage glottic squamous cell carcinoma involving the anterior commissure who underwent CO_(2)laser treatment.The study was divided into three groups:Group A with 15 cases,treated with staged resection surgery;Group B with 18 cases,treated with one-stage surgery combined with the placement of a silicone laryngeal stent;and Group C with 50 cases,treated with simple CO_(2)laser excision.The Voice Handicap Index-10(VHI-10),the GRBAS auditory-perceptual assessment,and the maximum phonation time(MPT)were used to evaluate the vocal function of the patients before and six months after surgery.The degree of vocal cord adhesion was assessed using the Cohen classification of vocal cord adhesion.Statistical analysis was performed to determine the differences in each indicator before and after surgery,and the primary tumor control rates among the three groups.Results Local recurrence occurred in 1 case each in Groups A and B,and in 4 cases in Group C,with no distant metastasis observed.Postoperative vocal cord adhesion of varying degrees occurred in a total of 77 cases,with an adhesion rate of 73.3%(11/15)in Group A,88.9%(16/18)in Group B,and 100%(50/50)in Group C.The postoperative vocal cord adhesion rate and degree in Group C were significantly higher than in Groups A and B.The postoperative VHI-10 scores in all three groups were significantly increased compared to preoperative scores(P<0.05),and when compared between groups postoperatively,Group C was significantly worse than Groups A and B(P<0.05).The postoperative maximum phonation time(MPT)in Group C was significantly reduced compared to preoperative and was markedly shorter than that of Groups A and

关 键 词：声门型喉癌 CO_(2)激光 前联合粘连 硅胶喉模 嗓音功能 

分 类 号：R767[医药卫生—耳鼻咽喉科]