声门上癌的激光手术

CO2激光是治疗喉恶性肿瘤的一种较新手段。目前,早期声门型喉癌的激光治疗效果已得到广泛认同,而对声门上型喉癌的激光治疗存在较多争议,本文就激光手术治疗声门上癌的历史、手术适应证、手术技术、疗效、功能恢复、手术并发症及应用前景作一综述。     

头颈外科学

CO2激光治疗早期声门型喉癌疗效分析目的:总结CO2激光手术治疗声门型喉癌的临床治疗效果。方法:对2002年4月～2007年5月安徽省立医院耳鼻咽喉头颈外科激光手术治疗的61例声门型喉癌进行临床分析。61例中,T1a33例,T1b     

CO_2激光在耳鼻咽喉头颈外科中的应用

随着医学模式的转变和外科技术的不断发展,微创手术成为21世纪发展的新趋势。激光结合内镜技术实现了耳鼻咽喉头颈外科手术的微创化,在学科的发展进程中发挥着重要作用。1972年Vaughan等[1]将CO2激光用于喉癌的治疗,并于1978年首先报道了应用CO2激光治疗喉癌的成功经验,随后这一治疗方法在许     

声门上癌的激光手术

CO_2激光是治疗喉恶性肿瘤的一种较新手段。目前,早期声门型喉癌的激光治疗效果已得到广泛认同,而对声门上型喉癌的激光治疗存在较多争议,本文就激光手术治疗声门上癌的历史、手术适应证、手术技术、疗效、功能恢复、手术并发症及应用前景作一综述。     

CO_2激光治疗早期喉声门型癌

1概况喉癌是我国常见的头颈肿瘤之一,多发于声门及声门上区。近年来,发病率有上升的趋势,这与社会发展,人们对该疾病的认知提高,早期就诊患者增多有密切关系。对于早期喉声门型癌,比较各种治疗方法,在彻底去除肿瘤和有效控制术后复发的前提下,从保存喉基本功能和减轻患者痛苦等方面考虑,目前多推崇CO2激光手术治疗(图1)。2历史1917年爱因斯坦提出受激辐射,奠定激光的理论基础。1960年梅曼制造出第一台激光器。1972年Vaughan等[1]将CO2激光用于喉癌的治疗,并于1978年首先报道了应用CO2激光治疗喉癌的成功经验,随后这一治疗方法在许多国家…     

CO2激光治疗喉癌前病变及早期声门型喉癌的疗效分析

目的 探讨CO2激光治疗喉癌前病变及早期声门型喉癌的临床效果.方法 选取2014年1月～2019年9月在我科行支撑喉镜下CO2激光显微手术治疗喉癌前病变及早期声门型喉癌患者30例(喉癌前病变20例,早期声门型喉癌10例),观察患者术后恢复情况.结果 30例患者均完成手术,术中均未出现并发症.3例患者因病灶累及前联合,术...     

早期声带癌的CO2激光微创治疗

目的 探讨CO2激光治疗早期声带癌（T1、T2）的疗效。方法 回顾性分析经CO2激光治疗的26例早期声带癌（T1a期12例、T1b期2例和T2期12例）疗效和手术并发症。结果 术后随访5～15个月,所有患者无严重并发症,发音功能恢复良好,复发3例（复发率11.5%）,再次行CO2激光手术2例,行全喉切除术1例。结论 CO2激光手术具有手术创伤小、并发症少和发音功能保留满意等优点,是早期声带癌理想的治疗方法。     

早期声门型喉癌钬激光与CO2激光手术对比研究

目的 比较钬激光与CO2激光手术治疗早期声门型喉癌临床疗效.方法 回顾性分析激光手术治疗早期声门型喉癌91例的患者临床资料(Tis,T1 N0 M0).依据治疗方式分为钬激光手术组56例,CO2激光手术组35例.对两组患者手术时间、出血量、并发症、住院时间、创面恢复时间和生存率等进行分析.结果 钬激光组与CO2激光组在...     

经口腔途径CO2激光治疗早期声门癌的手术创面恢复的观察

经口腔途径支撑喉镜下应用CO2激光在显微镜下切除早期喉癌符合当代外科学的发展方向,如显微操作、微创治疗,精准切除等,已经成为治疗早期喉癌(T1、T2)的首选治疗〔1〕。我们连续观察激光切除术喉癌的创面上皮化的过程,术后第1天,术后3个月内的每周及术后半年行电子喉镜检查,连续观察创面的变化,探讨CO2激光切除声门癌后愈合的过程。1资料与方法1.1临床资料2010-05-2011-11期间入院接受CO2激光治     

早期喉癌腔镜外科手术及放疗治疗进展

早期喉癌的治疗方式有腔镜外科治疗、开放性手术治疗、放疗等,其中腔镜外科手术治疗进展较快,主要手术方式有CO2激光切除术和低温等离子射频消融切除术。本文对早期喉癌该方面的国内外治疗进展做一综述。     

Laser surgery for the treatment of glottic carcinomas

PURPOSE: The standard treatment for patients with early glottic carcinoma in Israel has been radiotherapy. In recent years, encouraging results with laryngo-microscopic carbon dioxide laser surgery as a treatment for early glottic carcinoma has changed our treatment strategy. We conducted a retrospective study to investigate the results of carbon dioxide laser excisional technique for early glottic carcinoma (T1, T2). MATERIALS AND METHODS: Twenty-six had squamous cell carcinoma (SCC), (21 patients with T1 and 5 patients with T2 lesions), 3 had carcinoma in situ, (CIS) and 3 had verrucous carcinoma (VC). RESULTS: All patients were free of disease after salvage treatment at the most recent follow-up. CONCLUSIONS: Careful patient selection with endoscopic staging and strict follow-up are essential to secure good results in the treatment of carbon dioxide laser for early laryngeal carcinoma.     

早期声门型喉癌的治疗进展

声门型喉癌占喉癌发病的70%,淋巴结转移少见。早期声门型喉癌常常引起声音嘶哑,就诊过程中,易于早期发现,在所有喉癌中预后最好。近10年来美国国家综合癌症网络(NCCN)指南中关于早期声门型喉癌的诊治经历20余次的更新,已逐步形成经口内镜下CO₂激光手术或单纯放疗为主的治疗模式。喉功能保留和嗓音质量是衡量治疗成功与否的关键因素,目前开放手术的应用越来越少,而首选CO₂激光手术还是单纯放射治疗方案的问题一直是悬而未决的。本文将分别介绍早期声门型喉癌的治疗进展及个性化治疗选择的关键要点,并总结影响肿瘤复发的预后因素及预测复发的生物学标志物,以期为指导早期声门型喉癌患者的治疗及随访提供临床参考。     

CO2激光手术治疗声门型喉癌疗效分析

OBJECTIVE: To evaluate the curative effect of CO2 laser in treatment of glottic carcinoma. METHODS: Retrospective analysis of 217 cases of early glottic laryngeal carcinoma treated with laser surgery were carried out. Among these cases, Tis were 22 cases, T1a 108 cases, T1b 38 cases, T2 46 cases, T3 3 cases. 1 case being applied vocal cord excision due to failure of tumor exposure. The follow-up period was 3 to 9 years. RESULTS: Relapse were detected in 21 out of 217 cases of glottic laryngeal carcinoma after CO2 laser surgery under self-retaining laryngoscope. The recurrent rate was 9.7% (21/217). Recurrent ratio of T1a, T1b, T2, T3 were 5.6% (6/108), 21% (8/38), 13.0% (6/46), 1/3 respectively, with significant differences among groups (chi 2 = 6.102, P < 0.01). The recurrent rate was 21.6% of tumors offended the anterior commissure, versus 5.1%(8/157) with no involvement of anterior commissure (chi 2 = 13.64, P < 0.01). 217 cases received laser surgery as the only treatment, 201 cases were still alive. 4 failed to be followed-up(taken into dead number), 12 cases were dead. 3 year survival rate was 97.2%(211/217), 5 year survival rate was 89.4%(118/132). CONCLUSION: It was reliable to use laser surgery in treatment of early glottic laryngeal cancer. The advantages of it included lower complication rate and vocal function was well retained.     

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

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。     

CO2激光喉显微外科技术治疗喉良恶性病变

目的回顾分析应用CO2激光喉显微外科技术治疗喉部良恶性病变的效果。方法自1999年1月1日至2003年6月30日，应用CO2激光喉显微外科技术治疗喉部良恶性病变313例，其中采用切割或汽化方法切除声带息肉236例，声带小结30例；采用声带黏膜剥脱术切除声带白斑、声带角化症、声带不典型增生27例；应用声带黏膜剥脱术或声带切除术切除声门型喉癌(T1aN0M0％)20例。结果所有患者均一次切除病变，术中出血少或不出血，术野清楚。术后无一例出现呼吸困难、出血等严重并发症。声带息肉和声带小结患者的有效率达100％；声带白斑、角化症、不典型增生患者的有效率为92．6％；声门型喉癌患者半年复发率10％。结论应用CO2激光进行喉显微外科手术术中出血少、术野清楚，有效率高，拓展了手术的适应证和范围，值得推广应用。     

Comparison between transoral microsurgery by CO2 laser and conventional surgical therapy for T2 glottic carcinoma

BACKGROUND: Transoral CO2 laser excision of early glottic cancer was first introduced in the 1970s. Since then it has become a serious alternative to surgery with conventional instruments. PATIENTS AND METHODS: Between January 1987 and December 1997, 46 patients with T2 N0 M0 glottic carcinoma have been treated by either transoral laser microsurgery or fronto-lateral partial laryngeal resection with curative intention. Long-term results of both methods were compared after analysation of tumor-localization and recurrence-rate. Evaluation parameters were: incidence of local recurrence and incidence of death due to local recurrence. Other aspects of investigation were hospitalisation-time and treatment related patient morbidity. RESULTS: Analysis of the data of our study shows that local recurrences were 5 % lower in cases of laser surgical tumor resection as opposed to conventional surgery (11 % vs. 16 %). If evaluated in accordance to localization of local recurrence in combination with primary tumor localization, results show that all three recurrent tumors in the group of laser resected patients had a primary in the anterior glottic area; two out of the three recurrences following fronto-lateral laryngeal resection were localized in the mid-third of the vocal cord. Hospital-admittance in laser-resected patients was shorter by one day when compared with the group of conventional surgery (10 vs. 11 days). CONCLUSION: T2-Tumors of the anterior glottic area should preferably be approached by conventional surgery (external approach), particularly when endoscopical visualization is difficult. In contrast, T2-tumors of the medial and posterior glottic area should be resected endolaryngeally with the laser.     

Current trends in initial management of laryngeal cancer: the declining use of open surgery

The role of open surgery for management of laryngeal cancer has been greatly diminished during the past decade. The development of transoral endoscopic laser microsurgery (TLS), improvements in delivery of radiation therapy (RT) and the advent of multimodality protocols, particularly concomitant chemoradiotherapy (CCRT) have supplanted the previously standard techniques of open partial laryngectomy for early cancer and total laryngectomy followed by adjuvant RT for advanced cancer. A review of the recent literature revealed virtually no new reports of conventional conservation surgery as initial treatment for early stage glottic and supraglottic cancer. TLS and RT, with or without laser surgery or CCRT, have become the standard initial treatments for T1, T2 and selected T3 laryngeal cancer. Photodynamic therapy (PDT) may have an emerging role in the treatment of early laryngeal cancer. Anterior commissure involvement presents particular difficulties in application of TLS, although no definitive conclusions have been reached with regard to optimal treatment of these lesions. Results of TLS are equivalent to those obtained by conventional conservation surgery, with considerably less morbidity, less hospital time and better postoperative function. Oncologic results of TLS and RT are equivalent for glottic cancer, but with better voice results for RT in patients who require more extensive cordectomy. The preferred treatment for early supraglottic cancer, particularly for bulkier or T3 lesions is TLS, with or without postoperative RT. The Veterans Administration Study published in 1991 established the fact that the response to neoadjuvant CT predicts the response of a tumor to RT. Patients with advanced tumors that responded either partially or completely to CT were treated with RT, and total laryngectomy was reserved for non-responders. This resulted in the ability to preserve the larynx in a significant number of patients with locally advanced laryngeal cancer, while achieving local control and overall survival results equivalent to those achieved with initial total laryngectomy. Following this report, similar “organ preservation” protocols were employed in many centers. By 2003, results of the RTOG 93-11 trial, utilizing CCRT as initial treatment, were published, demonstrating a higher rate of laryngeal preservation with this protocol. Surgery was reserved for treatment failures. This concept changed the paradigm for management of advanced laryngeal cancer, greatly reducing the number of laryngectomies performed. While supracricoid laryngectomy has been employed for selected patients, total laryngectomy is the usual procedure for salvage of failure after non-surgical treatment.     

The role of laser microsurgery in the treatment of laryngeal cancer

PURPOSE OF REVIEW: Transoral laser microsurgery has developed in recent years into a surgical method that combines a minimally invasive approach with the surgical precision of laser and microscope. The outcomes of laser microsurgical treatment of laryngeal carcinomas are reviewed and compared with the results of competitive standard procedures. RECENT FINDINGS: Laser microsurgery is widely acknowledged to have advantages in the treatment of early glottic carcinoma. In the treatment of glottic carcinoma causing impaired mobility or fixation of the vocal cord the role of laser surgery has not yet been definitively assessed. Based on published results, primary laser therapy can achieve local tumor control with a functional residual larynx in approximately 70-80% of cases. In patients with early or moderately advanced supraglottic carcinoma, laser microsurgery is comparable to open supraglottic laryngectomy in terms of local control and survival. With regard to organ preservation, laser microsurgery is comparable to open supraglottic laryngectomy but superior to radiotherapy. Microsurgery can preserve functionally important structures, allowing for early swallowing rehabilitation while avoiding tracheotomy. SUMMARY: This review elucidates the role of laser microsurgical partial resections of the larynx in comparison with other treatment modalities.     

显微喉镜CO2激光喉癌切除术的远期疗效观察

目的：观察显微喉镜下CO2激光手术治疗早期喉癌的远期疗效和生存质量。方法：对20例喉癌患者在显微喉镜下行CO2激光手术。全部病例通过电话、书信和来院复诊等形式随访5～8年。结果：20例患者中,1例术后1年死于局部复发,1例术后2年局部复发行部分喉切除术,1例术后5年出现颈部淋巴结转移行二期颈廓清术,其余17例术后随访5～8年未见复发。5年总治愈率为85％,生存率为95％,局部复发率为10%,局部淋巴结转移率为5％。所有存活者呼吸通畅,发声良好,其中8例完全恢复日常工作,5例经常从事家务劳动,4例有时从事家务劳动。结论：T1及更早期的声门区和声门上区喉癌适合显微喉镜CO2激光手术,其5年生存率及生存质量令人满意,是治疗早期喉癌的较好选择。     

磷酸钛钾激光声带切除术治疗早期声门癌的疗效观察

目的：探讨磷酸钛钾（ＫＴＰ）激光声带切除术治疗早期声门癌的效果。方法：对３０例行激光声带切除术者（激光组）和１８例行喉裂开声带切除者（喉裂开组）术后的喉内结构变化、音质、生存质量等进行对比分析。结果：激光组半年后在原声带处长出一新声带，音质明显提高接近正常，生存提高较高。喉裂开组无新声带形成，音质半年内较好而后持续较差，生存质量在拔管前较低，拔管后同激光组。术后观察２～４年，激光组２例复发，喉裂开