山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (2): 9-15.doi: 10.6040/j.issn.1673-3770.1.2020.101

• 名家笔谈 • 上一篇    下一篇

等离子射频消融技术在早期声门型喉癌治疗中的应用进展

周恩,肖禹,肖旭平   

  1. 湖南师范大学附属第一医院/湖南省人民医院 耳鼻咽喉头颈外科, 湖南 长沙 410000
  • 发布日期:2021-04-20
  • 通讯作者: 肖旭平. E-mail:469784129@qq.com
  • 基金资助:
    湖南省卫生健康委附属医院临床创新技术建设项目(2020236)

Application progress of radiofrequency ablation technology in the treatment of early glottic carcinoma

ZHOU En, XIAO Yu, XIAO Xuping   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha 410000, Hunan, China
  • Published:2021-04-20

摘要: 早期声门型喉癌的治疗不仅要注重原发肿瘤的控制及无瘤生存率,也要关注喉结构的保护以及嗓音功能的保留策略,利于患者术后保持较高的生存质量。随着医疗技术、设备的进步,早期喉癌腔镜下保留喉功能的激光手术、机器人手术及等离子射频消融手术在临床中开展越来越广泛;现就等离子射频消融技术在早期声门型喉癌手术治疗中的应用进展做综述。

关键词: 等离子射频消融, 喉癌, 声门型, 疗效, 适应证

Abstract: Early glottic laryngeal cancer treatment should focus not only on controlling the primary tumor and optimizing the tumor-free survival rate, but also on the preservation of the healthy laryngeal tissue, the protection of the voice function of the larynx, and improving the patient's quality of life. With advancements in medical technology and equipment, the clinical application of endoscopically-monitored laser, robotic, and plasma radiofrequency ablation surgeries aimed at preserving laryngeal function in early laryngeal cancer have been gaining popularity. This article reviews the progress made in the application of plasma radiofrequency ablation to the surgical treatment of early glottic carcinoma.

Key words: Radiofrequency ablation, laryngeal carcinoma, Glottis, Efficacy, Indications

中图分类号: 

  • R767.91
[1] Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002[J]. CA: A Cancer J Clin, 2005, 55(2): 74-108. doi:10.3322/canjclin.55.2.74.
[2] He YT. Cancer Institute the Fourth Hospital of Hebei Medical University/the Tumor Hospital of Hebei Province Shijiazhuang China, Liang D, et al. Incidence and mortality of laryngeal cancer in China, 2015[J]. Chin J Cancer Res, 2020, 32(1): 10-17. doi:10.21147/j.issn.1000-9604.2020.01.02.
[3] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016[J]. CA: A Cancer J Clin, 2016, 66(1): 7-30. doi:10.3322/caac.21332.
[4] Hoffman HT, Porter K, Karnell LH, et al. Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival[J]. Laryngoscope, 2006, 116(S111): 1-13. doi:10.1097/01.mlg.0000236095.97947.26.
[5] 中华耳鼻咽喉头颈外科杂志编辑委员会头颈外科组, 中华医学会耳鼻咽喉头颈外科学分会头颈学组, 李晓明. 喉癌外科手术及综合治疗专家共识[J]. 中华耳鼻咽喉头颈外科杂志, 2014, 49(8): 620-626. doi:10.3760/cma.j.issn.1673-0860.2014.08.002.
[6] Carney AS, Timms MS, Marnane CN, et al. Radiofrequency coblation for the resection of head and neck malignancies[J]. Otolaryngol Head Neck Surg, 2008, 138(1): 81-85. doi:10.1016/j.otohns.2007.08.022.
[7] Zhang Q, She C, Song W, et al. Nasal mucosa recovery after endoscopic surgery using the plasma radiofrequency ablation at low temperature for treatment of nasal inverted Papilloma[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2014, 28(8): 520-522.
[8] 肖水芳, 赵欣, 张俊波, 等. 等离子射频技术辅助经口微创手术治疗口咽及口腔恶性肿瘤的临床观察[J]. 临床耳鼻咽喉头颈外科杂志, 2017,31(22): 1705-1710. doi:10.13201/j.issn.1001-1781.2017.22.001. XIAO Shuifang, ZHAO Xin, ZHANG Junbo, et al. Clinical observation of coblation assisted transoral microsurgery for the treatment of oral and oropharygneal malignancy[J]. J Clin Otorhinolaryngol Head Neck Surg, 2017, 31(22): 1705-1710. doi:10.13201/j.issn.1001-1781.2017.22.001.
[9] 苗刚勇, 肖旭平, 谭志强. 低温等离子射频技术在早期舌癌手术中的应用[J]. 中国耳鼻咽喉头颈外科, 2015,22(12): 601-603. doi:10.16066/j.1672-7002.2015.12.001. MIAO Gangyong, XIAO Xuping, TAN Zhiqiang. Application of low temperature radiofrequency volumetric tissue reduction in patients with tongue cancer[J]. Chin Arch Otolaryngol-Head Neck Surg, 2015,22(12), 22: 601-603. doi:10.16066/j.1672-7002.2015.12.001.
[10] Silver CE, Beitler JJ, Shaha AR, et al. Current trends in initial management of laryngeal cancer: the declining use of open surgery[J]. Eur Arch Otorhinolaryngol, 2009, 266(9): 1333-1352. doi:10.1007/s00405-009-1028-2.
[11] Patel TR, Eggerstedt M, Toor J, et al. Occult lymph node metastasis in early-stage glottic cancer in the national cancer database[J]. Laryngoscope, 2020, 18. doi:10.1002/lary.28995.
[12] Wang GY, Li GD, Wu JJ, et al. Analysis of prognostic factors for Tis-2N0M0 early glottic cancer with different treatment methods[J]. Braz J Otorhinolaryngol, 2020 doi:10.1016/j.bjorl.2020.06.013.
[13] Hendriksma M, Heijnen BJ, Sjögren EV. Oncologic and functional outcomes of patients treated with transoral CO2 laser microsurgery or radiotherapy for T2 glottic carcinoma: a systematic review of the literature[J]. Curr Opin Otolaryngol Head Neck Surg, 2018, 26(2): 84-93. doi:10.1097/moo.0000000000000438.
[14] Demir B, Binnetoglu A, Gurol E, et al. Comparison of voice quality of life in early stage glottic carcinoma treated with endoscopic cordectomy using radiofrequency microdissection electrodes, laser cordectomy, and radiotherapy[J]. J Voice, 2019. doi:10.1016/j.jvoice.2019.11.003.
[15] O'Hara J, Markey A, Homer JJ. Transoral laser surgery versus radiotherapy for tumour stage 1a or 1b glottic squamous cell carcinoma: systematic review of local control outcomes[J]. J Laryngol Otol, 2013, 127(8): 732-738. doi:10.1017/S0022215113001400.
[16] Ansarin M, Cattaneo A, De Benedetto L, et al. Retrospective analysis of factors influencing oncologic outcome in 590 patients with early-intermediate glottic cancer treated by transoral laser microsurgery[J]. Head Neck, 2017, 39(1): 71-81. doi:10.1002/hed.24534.
[17] 黄冠江, 罗梦思, 张靖萱, 等. T1a声门型喉癌患者激光和放射治疗后嗓音功能评估文献的Meta分析[J]. 听力学及言语疾病杂志, 2017, 25(5): 529-535. doi:10.3969/j.issn.1006-7299.2017.05.021. HUANG Guanjiang, LUO Mengsi, ZHANG Jingxuan, et al. A comparative assessment of voice after laser surgery versus radiotherapy of T1a glottic carcinoma: a meta-analysis[J]. J Audiol Speech Pathol, 2017, 25(5): 529-535. doi:10.3969/j.issn.1006-7299.2017.05.021.
[18] Greulich MT, Parker NP, Lee P, et al. Voice outcomes following radiation versus laser microsurgery for T1 glottic carcinoma: systematic review and meta-analysis[J]. Otolaryngol Head Neck Surg, 2015, 152(5): 811-819. doi:10.1177/0194599815577103.
[19] Taylor SM, Kerr P, Fung K, et al. Treatment of T1b glottic SCC: laser vs. radiation: a Canadian multicenter study[J]. J Otolaryngol Head Neck Surg, 2013, 42: 22. doi:10.1186/1916-0216-42-22.
[20] Hakeem AH, Tubachi J, Pradhan SA. Significance of anterior commissure involvement in early glottic squamous cell carcinoma treated with trans-oral CO2 laser microsurgery[J]. Laryngoscope, 2013, 123(8): 1912-1917. doi:10.1002/lary.24012.
[21] Canis M, Martin A, Ihler F, et al. Transoral laser microsurgery in treatment of pT2 and pT3 glottic laryngeal squamous cell carcinoma-results of 391 patients[J]. Head Neck, 2014, 36(6): 859-866. doi:10.1002/hed.23389.
[22] Lallemant B, Chambon G, Garrel R, et al. Transoral robotic surgery for the treatment of T1-T2 carcinoma of the larynx: Preliminary study[J]. Laryngoscope, 2013, 123(10): 2485-2490. doi:10.1002/lary.23994.
[23] Wang CC, Liu SA, Wu SH, et al. Transoral robotic surgery for early glottic carcinoma involving anterior commissure: Preliminary reports[J]. Head Neck, 2016, 38(6): 913-918. doi:10.1002/hed.24354.
[24] 鞠丽娴, 李井成, 罗松. 微创低温等离子射频消融术与垂直半喉切除术治疗早期声门型喉癌的疗效比较[J]. 武汉大学学报(医学版), 2019,40(4): 617-620. doi:10.14188/j.1671-8852.2018.0601. JU Lixian, LI Jingcheng, LUO Song. Effective comparison of minimally invasive low temperature plasma radiofrequency ablation versus vertical hemilaryngectomy in the treatment of early glottic cancer[J]. Med J Wuhan Univ, 2019,40(4): 617-620. doi:10.14188/j.1671-8852.2018.0601.
[25] 徐夏, 邓文婷, 黄成志, 等. 喉内镜下等离子消融术与开放性手术治疗早期喉癌的疗效对比[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 81-85. doi:10.6040/j.issn.1673-3770.0.2018.177. XU Xia, DENG Wenting, HUANG Chengzhi, et al. Curative effect analysis of endoscopic laryngeal surgery with plasma radiofrequency ablation versus open surgery to treat early glottic cancer[J]. J Otolaryngol Ophthalmol Shandong Univ, 2019, 33(2): 81-85. doi:10.6040/j.issn.1673-3770.0.2018.177.
[26] 黄畅. 等离子射频治疗早期声门型喉癌的术后并发症及疗效分析[D]. 大连: 大连医科大学, 2018. HUANG Chang. Complications and curative effect analysis about low temperature plasma radiofrequency treatment of early glottic cancer[D]. Dalian: Dalian Medical University, 2018.
[27] Shuang Y, Li C, Zhou X, et al. Outcomes of radiofrequency ablation(RFA)and CO2 laser for early glottic cancer[J]. Am J Otolaryngol, 2016, 37(4): 311-316. doi:10.1016/j.amjoto.2016.03.002.
[28] 双羽, 李超, 黄永望, 等. 低温等离子射频消融术与CO2激光治疗早期声门型喉癌疗效比较[J]. 听力学及言语疾病杂志, 2015, 23(4): 372-376. doi:10.3969/j.issn.1006-7299.2015.04.010. SHUANG Yu, LI Chao, HUANG Yongwang, et al. Comparison between radiofrequency coblation and CO2 laser for the treatment of early glottic carcinoma[J]. J Audiol Speech Pathol, 2015, 23(4): 372-376. doi:10.3969/j.issn.1006-7299.2015.04.010.
[29] Zhang Y, Wang BR, Sun GB, et al. Carbon dioxide laser microsurgery versus low-temperature plasma radiofrequency ablation for T1a glottic cancer: a single-blind randomized clinical trial[J]. Biomed Res Int, 2018, 2018: 4295960. doi:10.1155/2018/4295960.
[30] 谭凤武, 邓亚萍, 黎可华. 低温等离子射频消融与CO2激光手术治疗早期声门型喉癌疗效的Meta分析[J]. 山东大学耳鼻喉眼学报, 2020,34(6): 63-71. TAN Fengwu, DENG Yaping, LI Kehua. The therapeutic effects of low temperature plasma radiofrequency ablation and CO2 laser surgery on early glottic carcinoma: a Meta-analysis[J]. J Otolaryngol Ophthalmol Shandong Univ, 2020, 34(6): 63-71.
[31] Remacle M, Eckel HE, Antonelli A, et al. Endoscopic cordectomy. a proposal for a classification by the Working Committee, European Laryngological Society[J]. Eur Arch Oto-Rhino-Laryngol, 2000, 257(4): 227-231. doi:10.1007/s004050050228.
[32] Demir B, Binnetoglu A, Gurol E, et al. Comparison of voice quality of life in early stage glottic carcinoma treated with endoscopic cordectomy using radiofrequency microdissection electrodes, laser cordectomy, and radiotherapy[J]. J Voice, 2019. doi:10.1016/j.jvoice.2019.11.003.
[33] 刘卫兴, 陈桂, 宋丽娟, 等. 早期声门型喉癌经低温等离子射频消融术和CO2激光治疗的Meta分析[J]. 中华生物医学工程杂志, 2020, 26(1): 15-20. doi:10.3760/cma.j.issn.1674-1927.2020.01.003. LIU Weixing, CHEN Gui, SONG Lijuan, et al. Low-temperature plasma radiofrequency ablation and CO2 laser treatment for early glottic laryngeal cancer: a meta-analysis[J]. Chin J Biomed Eng, 2020, 26(1): 15-20. doi:10.3760/cma.j.issn.1674-1927.2020.01.003.
[34] 姜顺明, 龚晓成, 丁如良, 等. 低温等离子射频消融与CO2激光对喉癌前病变患者嗓音功能的影响[J]. 中华全科医学, 2019, 17(6): 966-968,973. doi:10.16766/j.cnki.issn.1674-4152.000837. JIANG Shunming, GONG Xiaocheng, DING Ruliang, et al. Effects comparison of low temperature plasma radiofrequency ablation and CO2 laser treatment on voice function of patients with laryngeal precancerous lesions[J]. Chin J Gen Pract, 2019, 17(6): 966-968,973. doi:10.16766/j.cnki.issn.1674-4152.000837.
[35] 折素珍, 王斌全, 李莹, 等. CO2激光治疗前连合受累的早期声门型喉癌的预后分析[J]. 临床耳鼻咽喉头颈外科杂志, 2015,29(24): 2121-2125. doi:10.13201/j.issn.1001-1781.2015.24.005. SHE Suzhen, WANG Binquan, LI Ying, et al. Prognostic analysis of CO2 laser surgery for early glottic cancer with anterior commissure involvement[J]. J Clin Otorhinolaryngol Head Neck Surg, 2015, 29(24): 2121-2125. doi:10.13201/j.issn.1001-1781.2015.24.005.
[36] Campo F, Zocchi J, Ralli M, et al. Laser microsurgery versus radiotherapy versus open partial laryngectomy for T2 laryngeal carcinoma: a systematic review of oncological outcomes[J]. Ear Nose Throat J, 2021, 100(1_suppl): 51S-58S. doi:10.1177/0145561320928198.
[37] Wang GY, Li GD, Wu JJ, et al. Analysis of prognostic factors for Tis-2N0M0 early glottic cancer with different treatment methods[J]. Braz J Otorhinolaryngol, 2020 doi:10.1016/j.bjorl.2020.06.013.
[38] Cabrera-Sarmiento JA, Vázquez-Barro JC, González-Botas JH, et al. T1b glottic tumor and anterior commissure involvement: is the transoral CO2 laser microsurgery a safe option?[J]. Ear Nose Throat J, 2021, 100(1_suppl): 68S-72S. doi:10.1177/0145561320937238.
[39] 周剑盛. CO2激光治疗早期声门型喉癌疗效的影响因素分析[D]. 杭州: 浙江大学, 2018.
[40] Peretti G, Piazza C, Cocco D, et al. Transoral CO2 laser treatment for Tis-T3 glottic cancer: the University of Brescia experience on 595 patients[J]. Head Neck, 2010, 32(8): 977-983. doi:10.1002/hed.21278.
[41] 杨淑芝, 周成勇, 王丰, 等. 经口低温等离子手术治疗侵犯前连合的早期声门型喉癌[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(2): 86-91. doi:10.3760/cma.j.issn.1673-0860.2018.02.002. YANG Shuzhi, ZHOU Chengyong, WANG Feng, et al. Analysis of curative effect of transoral radiofrequency ablation microsurgery on glottic carcinoma with anterior commissure involvement at the early stage[J]. Chin J Otorhinolaryngol Head Neck Surg, 2018, 53(2): 86-91. doi:10.3760/cma.j.issn.1673-0860.2018.02.002.
[42] 双羽, 李超, 黄永望, 等. 声门型喉癌低温等离子射频消融术治疗后局部复发与前联合受侵犯的关系[J]. 肿瘤防治研究, 2015, 42(10): 1024-1026. doi:10.3971/j.issn.1000-8578.2015.10.016. SHUANG Yu, LI Chao, HUANG Yongwang, et al. Relationship between local recurrence and anterior commissure involvement in early glottic laryngocarcinoma after radiofrequency coblation[J]. Cancer Res Prev Treat, 2015, 42(10): 1024-1026. doi:10.3971/j.issn.1000-8578.2015.10.016.
[43] 瞿姣, 冯瑶杰, 李青青, 等. 双能量CT诊断喉癌侵犯甲状软骨[J]. 中国医学影像技术, 2019,35(10): 1472-1476. doi:10.13929/j.1003-3289.201903152. QU Jiao, FENG Yaojie, LI Qingqing, et al. Dual-energy CT in diagnosis of thyroid cartilage invasion of laryngeal carcinoma[J]. Chin J Med Imaging Technol, 2019,35(10): 1472-1476. doi:10.13929/j.1003-3289.201903152.
[44] 李海洋, 陈晓红. 增强CT/MRI对恶性肿瘤侵犯甲状软骨的诊断价值研究[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(5): 372-376. doi:10.3760/cma.j.issn.1673-0860.2017.05.010. LI Haiyang, CHEN Xiaohong. Diagnostic value of enhanced CT/MRI for thyroid cartilage invasion by malignant tumor[J]. Chin J Otorhinolaryngol Head Neck Surg, 2017, 52(5): 372-376. doi:10.3760/cma.j.issn.1673-0860.2017.05.010.
[45] 刘海鹰, 王建宏, 李希平, 等. 内镜联合低温等离子治疗累及前连合的早期声门型喉癌的疗效观察[J]. 临床耳鼻咽喉头颈外科杂志, 2018,32(11): 854-857. doi:10.13201/j.issn.1001-1781.2018.11.013. LIU Haiying, WANG Jianhong, LI Xiping, et al. Clinical observation of radiofrequency coblation therapy in early Glottis cancer involving the anterior commissure with endoscope[J]. J Clin Otorhinolaryngol Head Neck Surg, 2018,32(11): 854-857. doi:10.13201/j.issn.1001-1781.2018.11.013.
[46] 戴俊, 怀德, 陈智斌. CO2激光联合低温等离子射频消融术治疗累及前联合早期声门型喉癌临床观察[J]. 中国肿瘤临床与康复, 2017,24(6): 670-672. doi:10.13455/j.cnki.cjcor.2017.06.09. DAI Jun, HUAI De, CHEN Zhibin. CO2 laser combined with plasma radiofrequency ablation at relatively low temperatures for early glottic cancer with anterior commissure involvement[J]. Chin J Clin Oncol Rehabilitation, 2017, 24(6): 670-672. doi:10.13455/j.cnki.cjcor.2017.06.09.
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