Objective

Evaluate the curative effect of CO₂ laser in treatment of laryngeal carcinoma

Wenming LI,Dongmin WEI,Ye QIAN,Shengda CAO,Ya XU,Dayu LIU,Xinliang PAN,Dapeng LEI

Journal of Otolaryngology and Ophthalmology of Shandong University 2018, 32 (6): 13-17. DOI: 10.6040/j.issn.1673-3770.1.2018.025

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Objective

To evaluate the curative effect of CO₂ laser in the treatment of laryngeal carcinoma.

Methods

A retrospective analysis of 152 cases of early laryngeal carcinoma treated with laser surgery between 2011 and 2014 was conducted. Among all cases, 11, 102, 31, and 8 were Tis, T1a, T1b, and T2 cases, respectively.

Results

After the CO₂ laser treatment, patients were discharged within 1-3 days. There were no complications, such as dyspnea and tracheotomy, during the perioperative period. The long-term pronunciation quality was satisfactory. The follow-up period was 4-8 years. The recurrence rate of glottic carcinoma was 8.2% (147 cases). Two patients had salvage surgery with CO₂ laser. Six patients had salvage partial laryngectomy and four cases total laryngectomy. The five-year overall survival rate was 96.6%. Five cases of supraglottic carcinoma were followed up for 5 years without recurrence.

Conclusion

CO₂ laser surgery is a minimally invasive, effective, and safe procedure for early laryngeal carcinoma. Satisfactory exposure, good surgical skills, and appropriate surgical indications are fundamental for the success of CO₂ laser treatment.

采用门诊随访与电话随访相结合的方式，统计3年生存率为100%，5年生存率为96.7%，其中12例在术后7~15个月复发，T1a期2例再次行激光切除手术，3例行喉部分切除术；T1b期3例行喉部分切除术，3例行全喉切除术，其中2例再次出现造瘘口复发死亡; T2期1例复发行全喉切除后远处转移死亡。1例T1b患者术后13个月出现颈部淋巴结转移，原发灶未见复发，行颈清扫术。5例声门上型患者随访5年以上无瘤生存。一例高龄患者分别于2012年、2014年、2018年三次行支撑喉镜下喉癌切除手术，三次均为T1a病变，目前85岁仍在随访中。2例在术后3年、4年后失访(表1)。

显微激光手术时的安全切缘一般为＞3 mm[4]，特别注意手术时应调整好激光的最佳工作状态，采用合适的功率、最佳的切割焦距，否则会加重组织的烧灼挛缩，影响边界的判定[7]。切除路径可以根据不同部位的手术采取不同的手术方式，对于累及前联合的病变可以采用从前到后的切除方法，首先自前联合上方切开至甲状软骨膜，借助声带的自然牵拉再向两侧切除。对于喉室受累者，可以适当切除同侧室带以充分暴露肿瘤[8]。有条件的医院还可以联合鼻内镜进行观察协助手术。本组手术患者参照欧洲喉科学会2000年分类及2007年补充分类：Ⅰ型—上皮下声带切除，适用于癌前病变或病理性检查；Ⅱ型—声韧带下声带切除，适用于微小浸润癌或有微小浸润可能的严重原位癌；Ⅲ型—经肌肉声带切除，适用于声带活动度好的小的浅表性癌，未侵及声带肌；Ⅳ型—声带完全切除，切除声带全层，适用于浸润声带的T1a病变，未侵犯前连合；Ⅴ型—切除包括对侧声带在内的扩大声带切除术，适用于肿瘤扩散至前连合表面而无深层浸润，且无会厌根或声门下累及；Ⅵ型—切除范围包括双侧声带前部，前连合，声门下黏膜及环甲膜，适用于前连合来源的肿瘤，扩散至一侧或两侧声带，而无甲状软骨受累[9]。手术中快速冰冻病理检查能够更好的帮助临床医生掌握手术安全切缘。