早期声门型喉癌CO_(2)激光切除术后术区暂时性异常上皮内乳头样毛细血管袢的变化特点分析  

Analysis of the characteristics of temporary abnormal IPCL changes in the surgical area after CO_(2) laser resection for early glottic laryngeal cancer

作　　者：刘小红[1] 谢萌 石瑶 曹楠 杨皓楠 任晓勇[1] 罗花南[1] LIU Xiaohong;XIE Meng;SHI Yao;CAO Nan;YANG Haonan;REN Xiaoyong;LUO Huanan(Department of Otolaryngology Head and Neck Surgery,the Second Affiliated Hospital of Xi'an Jiao Tong University,Xi'an,Shaanxi,710004,China)

机构地区：[1]西安交通大学第二附属医院耳鼻咽喉头颈外科,陕西西安710004

出　　处：《中国耳鼻咽喉头颈外科》2024年第11期681-685,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的分析早期声门型喉癌接受CO_(2)激光切除术后,术区暂时性异常上皮内乳头样毛细血管袢(intraepithelial papillary capillary loop,IPCL)的变化特点。方法回顾性研究2017年1月~2023年11月就诊于西安交通大学第二附属医院耳鼻咽喉头颈外科,且接受支撑喉镜CO_(2)激光切除术的早期声门型喉癌患者,在术后1、3、6个月复查电子喉镜的无复发者,包括普通白光内镜和窄带成像内镜(NBI),系统收集患者病史、治疗方式、治疗前后喉镜图片、影像学资料和病理结果,分析其术后不同随访时间喉镜特征的变化规律。结果本研究纳入接受支撑喉镜CO_(2)激光手术的无复发早期声门型喉癌55例。术后1、3、6个月,术区表面出现伪膜覆盖(72.73%、25.45%、7.27%)、肉芽形成(60.00%、34.55%、1.82%)和异常IPCL(23.64%、7.27%、0.00%)的比例均有显著性差异(P<0.001)。术后1~3个月内术区表面伪膜覆盖、肉芽形成,NBI内镜下可出现异常IPCL(主要为Va型粗大斑点和Vb型扭曲血管),至术后6个月内伪膜脱落、肉芽消退、瘢痕形成,异常IPCL均消失。结论早期声门型喉癌患者在接受支撑喉镜CO_(2)激光切除术后3个月内可出现暂时性异常IPCL,但术后6个月内异常IPCL可消失,故术后6个月内可考虑密切观察,不急于活检。OBJECTIVE To analyze the changes of temporary abnormal intraepithelial papillary capillary loop(IPCL)in the surgical area of early glottic laryngeal cancer after CO_(2) laser resection.METHODS A retrospective study was conducted on early-stage glottic carcinoma patients who visited the Department of Otolaryngology,Head and Neck Surgery at the Second Affiliated Hospital from January 2017 to November 2023.Patients who underwent CO_(2) laser surgery accepted electronic laryngoscopy examination at 1 month,3 months,and 6 months postoperatively(including white light endoscopy and narrowband imaging endoscopy(NBI),and their medical history,treatment methods,laryngoscopy images,imaging data,and pathological results before and after treatment were systematically collected.The changes in laryngoscopy characteristics at different followup times after surgery were analyzed.RESULTS This study included 55 patients with non recurrent early glottic carcinoma who underwent CO_(2) laser surgery.At 1 month,3 months,and 6 months after surgery,there were significant differences in the proportion of patients with pseudomembrane coverage(72.73%vs.25.45%vs.7.27%),granulation formation(60.00%vs.34.55%vs.1.82%),and abnormal IPCL(23.64%vs.7.27%vs.0.00%)on the surface of the surgical area(P<0.001),and abnormal IPCL(mainly type Va and Vb)can be observed under NBI endoscopy from 1 month to 3 months after surgery.Within 6 months after surgery,the pseudomembrane detachment,granulation regression,scar formation,and abnormal IPCL in the surgical area disappeared.CONCLUSION Early glottic carcinoma patients may experience temporary abnormal IPCL within 3 months after receiving CO2 laser resection,but the abnormal IPCL could disappear within 6 months after surgery for some patients.Therefore,close observation is necessary within 6 months after surgery and there is no need for urgent biopsy.

关 键 词：喉肿瘤 CO_(2)激光 早期声门型喉癌 上皮内乳头样毛细血管袢 窄带成像内镜 黏膜稳定 

分 类 号：R739.65[医药卫生—肿瘤]