CO2激光显微手术在喉癌前病变和早期声门型喉癌中的应用

doi:10.6040/j.issn.1673-3770.0.2019.501

摘要/Abstract

摘要： 目的探讨CO₂激光显微手术在喉癌前病变和早期声门型喉癌治疗中的应用价值。方法选取南京医科大学附属南京医院耳鼻咽喉科自2014年1月~2018年8月期间收治的27例行CO₂激光显微手术治疗的喉癌前病变(9例)和早期声门型喉癌(18例)作为研究对象,观察术后并发症、对比手术前后的生活质量及术后1~2年局部的复发率,探讨其应用价值。结果根据CO₂激光显微手术切除的范围和深度进行手术:9例癌前病变中8例行I型手术、1例行Ⅱ型手术;18例早期声门型喉癌中3例行Ⅱ型手术、11例行Ⅲ型手术、3例行Ⅳ型手术、1例行Ⅴ型手术。1例因切缘阳性改行开放式手术,其余患者均未行气管切开,亦无气道烧伤等严重并发症。患者术后6 h软食,均无呛咳、呼吸困难等不良反应,术后抗感染抗炎治疗2~3 d。术后随访1~2年,嗓音恢复可。结论 CO₂激光显微手术治疗喉癌前病变和早期声门型喉癌临床效果显著、安全性较高、创伤小、术后嗓音恢复快、住院时间缩短、并能较为理想的保留喉功能、提高患者术后的生活质量。

关键词: CO₂激光显微手术, 喉癌前病变, 早期声门型喉癌, 支撑喉镜, 预后

Abstract: Objective This study aimed to investigate the clinical applications of CO₂ laser microsurgery for laryngeal precancerous lesions and early glottic laryngeal cancer. Methods A total of 27 patients, nine diagnosed with laryngeal precancerous lesions and 18 with early glottic laryngeal cancer, who had undergone CO₂ laser microsurgery were selected from January 2014 to August 2018 from the otolaryngology department of the Nanjing First Hospital(Nanjing Medical University). We observed the postoperative complications, the before and after surgery quality of life, and the postoperative 1~2-year local recurrence rate and evaluated the therapeutic effects of CO₂ laser microsurgery. Results Patients were classified into two groups depending on the scope and depth of CO₂ laser microsurgical resection. In the precancerous lesions group, eight patients received a type I operation and one patient received a type II operation. In the glottic laryngeal cancer group, three patients received a type II operation, 11 patients received a type III operation, three patients received a type IV operation, and one patient received a type V operation. One patient underwent open surgery because the surgical margin was positive. None of the other patients underwent tracheotomy, and no serious complications such as airway burns were noted. The patients were offered soft food six hours after surgery; no adverse reactions such as choking or dyspnea were observed. Further, the patients received anti-infective and anti-inflammatory treatment for 2-3 days after surgery. The patients were followed up for 1~2 years postoperatively. The voices of the patients recovered after the operation. Conclusion CO₂ laser laryngeal microsurgery has significant clinical applications in the treatment of laryngeal precancerous lesions and early glottic laryngeal carcinoma, leading to increased safety, less trauma, faster voice recovery, and shorter hospitalization times, in turn leading to larynx function preservation and improvements in the postoperative quality of life.

Key words: CO₂ laser laryngeal microsurgery, Laryngeal precancerous lesions, Early glottic laryngeal carcinoma, Suspension laryngoscope, Prognosis

中图分类号:

R767

徐进敬,胡京华,吴元庆,邓毅,喻唯唯. CO₂激光显微手术在喉癌前病变和早期声门型喉癌中的应用[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 129-133.

XU Jinjing, HU Jinghua, WU Yuanqing, DENG Yi, YU Weiwei. Applications of CO₂ laser microsurgery on laryngeal precancerous lesions and early glottic laryngeal carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(3): 129-133.

参考文献

[1] 周梁, 吴海涛, 黄维庭, 等. CO₂激光在声门型喉癌外科治疗中的应用[J]. 中华耳鼻咽喉头颈外科杂志, 2008, 43(10): 742-745. doi: 10.3321/j.issn:1673-0860.2008.10.005. ZHOU Liang, WU Haitao, HUANG Weiting, et al. Treatment of glottic cancer with CO₂ laser[J]. Chinese JOurnal of Otorhinolaryngology Head and Neck Surgery, 2008, 43(10): 742-745. doi: 10.3321/j.issn:1673-0860.2008.10.005.
[2] Peretti G, Nicolai P, Piazza C, et al. Oncological results of endoscopic resections of Tis and T1 glottic carcinomas by carbon dioxide laser[J]. Ann Otol Rhinol Laryngol, 2001, 110(9): 820-826. doi:10.1177/000348940111-000904.
[3] Hoffmann C, Cornu N, Hans S, et al. Early glottic cancer involving the anterior commissure treated by transoral laser cordectomy[J]. Laryngoscope, 2016, 126(8): 1817-1822. doi:10.1002/lary.25757.
[4] Rosier JF, Grégoire V, Counoy H, et al. Comparison of external radiotherapy, laser microsurgery and partial laryngectomy for the treatment of T1N0M0 glottic carcinomas: a retrospective evaluation[J]. Radiother Oncol, 1998, 48(2): 175-183. doi:10.1016/s0167-8140(98)00058-9.
[5] 周红林,徐东亮,鲁茂松, 等. CO₂激光显微手术治疗喉癌前病变的疗效分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2018, 26(6): 454-456. doi: 10.16542/j.cnki.issn.1007-4856.2018.06.014. Zhou Honglin, Xu Dongliang, Lu Maosong, et al. Efficacy evaluation of carbondioxide laser in the treatment of laryngeal precancerous lesions[J]. Chin J Otorhinolaryngol Integ Med, 2018, 26(6): 454-456. Doi: 10.16542/j.cnki.issn.1007-4856.2018.06.014.
[6] 雷磊, 王敏, 赵鑫, 等. CO₂激光治疗喉癌前病变临床疗效的Meta分析[J]. 中国肿瘤, 2017, 26(6): 482-489. doi: 10.11735/j.issn.1004-0242.2017.06.A013. Lei Lei, Wang Min, Zhao Xin, et al. Efficacy of carcon dioxide laser for treatment of laryngeal precancerous lesion: a meta-analysis[J]. China Tumor J, 2017, 26(6): 482-489. doi: 10.11735/j.issn.1004-0242.2017.06.A013.
[7] 雷文斌, 刘其洪, 柴丽萍, 等. 成人喉乳头状瘤64例CO₂激光黏膜下完整剥离术[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(10): 727-732. doi:10.3760/cma.j.issn.1673-0860.2016.10.003. LEI Wenbin, LIU Qihong, CHAI Liping, et al. Therapy of adult-onset laryngeal Papilloma: integrallty submucosal dissection of the tumor by CO₂ laser[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2016, 51(10): 727-732. doi:10.3760/cma.j.issn.1673-0860.2016.10.003.
[8] 李晓明, 宋琦. 喉癌治疗后复发的外科手术治疗[J]. 中华耳鼻咽喉头颈外科杂志, 2014, 49(8): 701-704. doi: 10.3760/cma.j.issn.1673-0860.2014.08.018.
[9] Wang Y, Li XT, Pan ZM. Analyses of functional and oncologic outcomes following supracricoid partial laryngectomy[J]. Eur Arch Otorhinolaryngol, 2015, 272(11): 3463-3468. doi:10.1007/s00405-014-3363-1.
[10] 卢岭, 杨丽萍, 梁耕田. 激光治疗喉癌癌前病变的疗效观察与分析[J]. 中国耳鼻咽喉颅底外科杂志, 2013, 19(2): 160-162. doi:10.11798/j.issn.1007-1520.201302023.
[11] 徐凌, 牛银花, 苏日格, 等. 支撑喉镜下CO₂激光术治疗声门型喉癌的疗效观察[J]. 中国医师杂志, 2019, 21(2): 215-219. doi: 10.37601/cma.j.issn.1008-1372.2019.02.014. Xu Ling, Niu Yinhua, Su Rige, et al. Effect of CO₂ laser assisted laryngoscope on glottic carcinoma[J]. Journal of Chinese Physician, 2019, 21(2): 215-219. doi: 10.37601/cma.j.issn.1008-1372.2019.02.014.
[12] 黄志刚. CO₂激光手术治疗咽喉部肿瘤[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 1-3. doi: CNKI:SUN:SDYU.0.2018-06-001. HUANG Zhigang. Treatment of throat tumors with CO₂ laser[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(6): 1-3. doi: CNKI:SUN:SDYU.0.2018-06-001.
[13] Ding S, Huang JW, Huang ZG, et al. Variation in prognosis of early laryngeal carcinoma after different types of cordectomy with transoral laser microsurgery[J]. Acta Otolaryngol, 2018, 138(8): 741-745. doi:10.1080/00016489.2018.1439592.
[14] 王琦, 徐霖, 汪文斌, 等. 早期声门型喉癌CO₂激光术后创面的动态观察[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(4): 289-293. doi:10.3760/cma.j.issn.1673-0860.2016.04.010. WANG Qi, XU Lin, WANG Wenbin, et al. Wound healing following laser cordectomy for early glottic carcinoma[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2016, 51(4): 289-293. doi:10.3760/cma.j.issn.1673-0860.2016.04.010.
[15] Succo G, Crosetti E, Bertolin A, et al. Benefits and drawbacks of open partial horizontal laryngectomies, Part A: Early- to intermediate-stage glottic carcinoma[J]. Head Neck, 2016, 38(Suppl 1): E333-E340. doi:10.1002/hed.23997.
[16] 郭建东, 尤慧华, 施海明, 等. CO₂激光治疗早期喉癌50例临床分析[J]. 江苏医药, 2019,45(5):536-537. doi: 10.19460/j.cnki.0253-3685.2019.05.033. Guo Jiandong, You Huihua, Shi Haiming, et al. Clinical analysis of 50 cases of early laryngeal cancer treated by CO₂ laser[J]. Jiangsu Med J, 2019,45(5):536-537. doi: 10.19460/j.cnki.0253-3685.2019.05.033.
[17] 许洪波, 房居高, 李平栋, 等. CO₂激光喉手术中气管内燃烧的分级预防策略[J]. 中国耳鼻咽喉头颈外科, 2017, 24(7): 333-336. doi:10.16066/j.1672-7002.2017.07.002. XU Hongbo, FANG Jugao, LI Pingdong, et al. Grading prevention strategy for airway burn during CO₂ laser surgery of larynx[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2017, 24(7): 333-336. doi:10.16066/j.1672-7002.2017.07.002.
[18] 李文明, 魏东敏, 钱晔, 等. 支撑喉镜下CO₂激光治疗喉癌的疗效分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 13-17. doi: CNKI:SUN:SDYU.0.2018-06-004. LI Wenming, WEI Dongmin, QIAN Ye, et al. Evaluate the curative effect of CO₂ laser in treatment of laryngeal carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(6): 13-17. doi: CNKI:SUN:SDYU.0.2018-06-004.
[19] 黎景佳, 张剑利, 何发尧, 等. 经口CO₂激光手术治疗前连合受累的声门型喉癌疗效观察[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(5): 337-342. doi:10.3760/cma.j.issn.1673-0860.2017.05.004. LI Jingjia, ZHANG Jianli, HE Fayao, et al. Treatment of glottic cancer involving the anterior commissure by transoral CO₂ laser surgery[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017, 52(5): 337-342. doi:10.3760/cma.j.issn.1673-0860.2017.05.004.
[20] 唐瑶, 沈晓辉, 钱晓云, 等. 喉癌术后复发时间的相关因素及预后分析[J]. 中国耳鼻咽喉颅底外科杂志, 2019, 25(2): 177-182. doi:10.11798/j.issn.1007-1520.201902016. TANG Yao, SHEN Xiaohui, QIAN Xiaoyun, et al. Correlation factors and prognosis of postoperative recurrence of laryngeal carcinoma[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2019, 25(2): 177-182. doi:10.11798/j.issn.1007-1520.201902016.
[21] 万光伦, 葛冲, 孙敬武, 等. 经口内镜下CO₂激光切除Tis~T2期声门型喉癌复发相关因素分析[J]. 听力学及言语疾病杂志, 2017,25(6):619-622. doi:10.3969/j.issn.1006-7299.2017.06.016. Wan Guanglun,Ge Chong,Sun Jingwu, et al. The analysis of the recurrence factors of CO₂ laser surgery for Tis,T1 and T2 gIottic cancer[J].Journal of Audiology and Speech Pathology, 2017,25(6):619-622. doi:10.3969/j.issn.1006-7299.2017.06.016.
[22] 刘鸣. 早期声门癌的内镜治疗[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 6-9. doi: 10.6040/j.issn.1673-3770.1.2019.037. LIU Ming. Transoral laser microsurgery for early glottic neoplasms[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 6-9. doi: 10.6040/j.issn.1673-3770.1.2019.037.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed

CO₂激光显微手术在喉癌前病变和早期声门型喉癌中的应用

Applications of CO₂ laser microsurgery on laryngeal precancerous lesions and early glottic laryngeal carcinoma

PDF (PC)

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

多维度评价

本文评价

推荐阅读 0

[1]	刘佳珲,田汝宪,李玉梅,宋西成. 构建铜死亡相关lncRNA模型评估头颈鳞状细胞癌预后[J]. 山东大学耳鼻喉眼学报, 2026, 40(2): 49-64.
[2]	缪红利,张妍春,郝琳娜,唐乐,何英楠. 活动性眼弓形虫病临床特征及预后分析[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 82-89.
[3]	彭中华,陈竹,袁洛花,余绍兰,马玉玲. 原发性鼻腔高级别非肠型腺癌1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 95-98.
[4]	李赞,卢奇,申卫东,侯昭晖,吴南. 坏死性外耳道炎临床诊治18例[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 17-22.
[5]	刘玉柱,陈尧,苑铁君,李春森,李波. 喉纤维肉瘤1例并相关文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 133-137.
[6]	黄佳丽,刘梓琪,徐娟,陈曦,张立庆,周涵. 咽部梭形细胞鳞状细胞癌的临床及预后分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 94-100.
[7]	李美辰,陈海玲,李阳,马登殿. 下鼻甲黏液囊肿1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 91-94.
[8]	杨开炎, 唐凤珠, 覃启才, 李旭祥, 冯大益, 农丰靖, 杨秋云. 异常纺锤体样小头畸形相关蛋白在鼻咽癌中的表达及其临床意义[J]. 山东大学耳鼻喉眼学报, 2024, 38(3): 18-25.
[9]	王凯健,陈雪生,王威. 血小板-淋巴细胞比值与喉鳞状细胞癌预后相关性的Meta分析[J]. 山东大学耳鼻喉眼学报, 2024, 38(3): 67-73.
[10]	张佳佳,石安妮,邢御,洪玉颖,白鹏. 针刺联合西药治疗全聋型突发性聋1例与文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(3): 88-92.
[11]	张永红,张辉,王彩华,杨欣欣,吴允刚,赵玉凤,庞太忠,李晓瑜. 基于TCGA数据库构建喉鳞状细胞癌免疫相关基因预后模型及筛选靶向分子药物[J]. 山东大学耳鼻喉眼学报, 2023, 37(5): 54-62.
[12]	刘楠,逄明杰. 鼻内镜泪囊鼻腔吻合术预后影响因素的研究进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(5): 149-155.
[13]	吴波,黄天德,闫斌,陈伊,汤勇. 焦虑抑郁状态与特发性耳鸣预后的相关性研究[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 46-52.
[14]	孙永强,宋忠义,王春芳,李晓,傅莹,潘新良. 镫骨肌反射阈存在的突聋患者预后及影响因素[J]. 山东大学耳鼻喉眼学报, 2023, 37(2): 7-14.
[15]	韩飞燕,王英. 鼻腔鼻窦神经鞘瘤13例临床分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(2): 21-25.