Transoral CO2 laser for surgical management of glottic carcinoma in situ

OBJECTIVES/HYPOTHESIS: In carcinoma in situ (CIS) tumors malignant cells have not penetrated the basement membrane and therefore have no metastatic potential. Treatment strategies of CIS are topics of ongoing discussion. The aim of this study was to evaluate long-term results of CO2 laser therapy in laryngeal CIS. METHODS: From 1986 to 1995, 29 patients with glottic CIS with a minimum follow-up of 2 years were treated initially with transoral CO2 laser surgery and were included is this series. RESULTS: A complete removal of the tumor was possible with superficial laser cordectomy in 21 patients and with subligamental laser cordectomy in 8 cases. There was no tumor-related death in this series. Repeated laser resections were performed in four patients for local recurrences. No patient required total laryngectomy or radiotherapy during a follow-up ranging from 25 to 143 months. CONCLUSIONS: Local control rates presented in this study are superior to those previously reported with conventional surgery and similar to those after radiotherapy. The ultimate rate of larynx preservation was seven times higher than reported after radiotherapy. Our results add further support to the observation that laser surgery is the best treatment option for CIS of the larynx. Based on the material of this study, recommended treatment for CIS is CO2 laser resection in combination with a meticulous follow-up for early recognition of local recurrence.     

Glottische Larynxkarzinome

BACKGROUND: Endoscopic laser resection is one treatment modality for early glottic carcinoma. Benefits are the preservation of laryngeal structure without tracheotomy, the short duration of treatment, low traumatisation and good functional results. METHODS: From 1989 to 1999, 143 patients with an isolated and previously untreated glottic squamous cell carcinoma were treated by CO2 endoscopic laser resection. The tumors were classified as carcinoma in situ (Tis) in seven cases, T1 tumor (T1N0M0) in 91 patients and T2 tumor (T2N0M0) in 45 cases. Median follow-up was 5 years. RESULTS: For the group of Tis and T1 carcinomas, 86 of 98 patients were free of recurrences. The 12 recurrences (12.2%) were treated by repeated laser surgery and laryngectomy (four patients). None of these patients died of tumor related causes. For patients with T2 carcinomas, the overall recurrence rate was 28.9% (13 patients). In six patients, a total laryngectomy had to be performed and one patient died because of tumor recurrence. The relapse free survival estimate using the Kaplan-Meier method was 87% for Tis and T1 carcinomas and 70% for T2 carcinomas. The overall laryngeal preservation rate was 95% for Tis and T1 carcinomas and 85% for T2 tumors. All recurrences occurred within 4 years of primary surgery. CONCLUSION: The results suggest that the oncological outcome after endoscopic laser surgery is comparable to conventional open partial resections.     

Early-stage glottic cancer: oncological results and margins in laser cordectomy

OBJECTIVES: To assess local control of early-stage glottic cancer by laser cordectomy in comparison with previously published external partial laryngectomy series and to determine the relevance of histological margins in glottic cancers excised with laser cordectomy. DESIGN: Retrospective review of laser cordectomy for carcinoma in situ (Tis) and stage T1 glottic cancer from January 1991 to January 2004. SETTING: University hospital. PATIENTS: Fifty-two patients with Tis or T1 glottic cancer. INTERVENTION: Endoscopic laser cordectomy, classified using the system proposed by the European Laryngeal Society Working Committee. MAIN OUTCOME MEASURES: Local control after initial surgery and after salvage compared with a published historical control group, according to the type of cordectomy performed and the histological margins of the removed specimen. RESULTS: Sixteen patients with Tis, 30 with T1a tumors, and 6 with T1b tumors were followed up for an average of 38 months. Type I cordectomy was the most common procedure used to treat Tis, and type II and type III were the most common for treating T1a and T1b tumors. Of 6 recurrences, 4 were treated with laser cordectomy and 2 were treated with external partial laryngectomy. The rate of laryngeal preservation was 100%. There were 3 recurrences despite histologically clear margins. Three (17%) of 18 patients with suspicious margins developed recurrences. The rate of local control with single intervention (46 [89%] of 52) was lower than with partial external laryngectomy. However, 46 (89%) of 52 patients ultimately had less tissue removed by laser than would have been removed by external partial laryngectomy. CONCLUSIONS: Laser cordectomy provides excellent local control and laryngeal preservation. Close follow-up of patients with positive or suspicious margins is an alternative to further routine treatment.     

Our experience in CO2 laser surgery for early glottic carcinoma

In the years 1990-2002 187 patients were treated laser microsurgery due to T1, T2 laryngeal cancer. One of the purposes of this work was analysis of resurgery cases due to recurrence of neoplasmatic process after laser cordectomy, therefore a group of 93 patients, treated in the years 1990-1997 was controlled. The local recurrence of neoplasmatic process was observed in 13 persons. The changes were once more removed in laser microsurgery in 5 patients. In 8 persons total laryngectomy was performed with subsequent radiological treatment. The best results of treatment were observed in patients in whom changes were limited to medial part of vocal cord while recurrences were the most often in patients with anterior commissure lesion. In case of recurrences after laser microsurgery all other kinds of possible treatment can be applied as, partial conventional surgery, total laryngectomy, X-ray therapy or repeated laser microsurgery. Functional evaluation of voice in 64 patients, who due to early stage of carcinoma were submitted unilateral CO2 laser cordectomy, was performed. The appearance and mobility of larynx were registered and evaluated in particular periods post surgery, the patients voices were registered and acoustic analysis submitted. Gradual voice improvement following the wound healing were observed in subjective patients evaluation as in objective one. In many cases very good functional results were obtained, which made possible for patients after CO2 laser cordectomy to continue work requiring good function of larynx. In 43 patients the psychological aspect of laser microsurgery influence was analyzed by use of anonymous questionnaires. It proofed, that in the majority of cases, the laser surgery had no influence for the social and company life of people submitted laser cordectomy. In 7 patients the views of larynx were very specific on the free edge of scar after removed vocal cord--spherical structure of 3-5 mm diameter has appeared in 2 to 6 months after laser cordectomy. In pathological examination--laryngitis chronica, granulatio--was stated. In further observation of patients no recurrences were observed. The described changes resemble granulomas and the most probably are caused by laser ray. Higher power lasers are useful, even when used at the same wattage as older models as they produce less carbonization of tissue during use.     

Treatment of early-stage glottic cancer by transoral laser resection

OBJECTIVES: We reviewed outcomes of treatment of early glottic carcinoma by transoral laser resection. METHODS: We performed a retrospective study of tumor stage, type of cordectomy (European Laryngological Society), resection margins, local control, and laryngeal preservation. RESULTS: Of 142 patients treated with curative intent, 79 (92% male; average age, 63 years) were retained for this study, on the basis of availability of information regarding resection margins, the absence of adjuvant radiotherapy, and followup of at least 2 years. The tumors were classified pTis (n = 21), pT1a (n = 51), or pT1b (n = 7) and were treated by cordectomy types I (23%), II (30%), III (27%), IV (6%), and V (14%). The average follow-up was 56 months (range, 24 to 150 months). The overall 5-year actuarial recurrence-free survival rate was 89%, and the 5-year actuarial disease-specific survival rate was 97.3%. There were 11 local recurrences (14%); 7 were treated by another laser resection, 1 by radiotherapy, 1 by supracricoid partial laryngectomy, and 2 by total laryngectomy. The overall rate of final local control with the laser alone was 100% for patients with initially positive margins, 95% for those with initially suspicious margins, and 94% for those with free margins. The overall rate of organ preservation was 100% for patients with positive or suspicious margins and 96% for those with free margins. Margin status (p = .39), cordectomy type (p = .67), and anterior commissure involvement (p = .16) were not statistically related to recurrence (Kaplan-Meier calculations with nonparametric univariate analysis). The recurrence rate was significantly higher for T1b tumors, however (p = .001). CONCLUSIONS: Laser microresection provides high rates of local control and organ preservation for early glottic cancer. Positive or suspicious margins were not related to recurrence, nor was anterior commissure involvement. This study implies that suspicious margins can be managed with a "watch-and-wait" attitude. Re-treatment with laser, external partial laryngectomy, and radiotherapy remain therapeutic options for recurrences.     

喉疣状癌的临床分析

目的：分析喉疣状癌的临床病理特点、手术方式和疗效。方法：经病理证实的喉疣状癌患者10例，5例行垂直半喉+重建术；2例行环状软骨上喉部分切除+环舌会厌吻合术（CHEP）；2例行支撑喉镜下YAG激光声带切除术，其中1例术后放疗，另1例4个月后原位复发，行垂直半喉+重建术后控制；1例行喉裂开声带切除术。结果：所有患者均恢复正常的呼吸和吞咽功能，9例插管患者拔除气管套管后均获得正常的发音功能。术后随访：1例患者原位复发，1例因其他部位肿瘤死亡，2例因心脑血管疾病死亡。全部患者手术部位癌细胞无远处转移，5年生存率75%。结论：喉疣状癌是高分化鳞状细胞癌的一种特殊类型，本病确诊有赖于病理专家与喉科医师密切配合。手术是喉疣状癌主要的治疗方式，在切除肿瘤的基础上保留喉功能，提高患者生活质量     

声门型喉癌激光声带切除术后复发病例临床分析

目的：了解支撑喉镜下激光声带切除术治疗早期声门型喉癌复发的临床特点及如何选择再治疗方案。方法：采用波长为532nm的非接触式KTP激光,根据肿瘤大小和侵及深度选择不同术式：Ⅰ型声带切除术16例,Ⅱ型声带切除术63例,Ⅲ型声带切除术21例;对患者术后的复发时间、复发部位、选用术式及原发病变范围等进行分析。结果：1例在术后2个月复发,行激光手术切除,3个月后再复发,再行扩大垂直半喉切除,观察4年无复发。2例在术后3个月复发,1例在术后6个月复发,均行扩大垂直半喉切除,观察4年无复发。1例在术后1年复发,行全喉切除治疗。复发部位在前连合处4例,声带中部1例,其中原发病变T1a 3例,复发率为3．1％;T1b2例,复发率为50．0％。结论：激光声带切除术后复发时间多在半年内,复发部位多在前连合处,早期发现后应首选扩大的部分喉切除术;严格选择手术适应证,熟练的手术技巧是提高疗效的关键。     

Preliminary results of endolaryngeal laser resections of laryngeal cancers

From 1986 to 1988 ninety four patients with carcinoma of the larynx were treated by endoscopic laser surgery. Follow-up ranges from 3 to 39 months with a mean value of 23 months. Ninety patients were operated on with curative intent and 4 with palliative intent. In 7 cases of T3 tumors a complete removal of the tumor was not possible, so that a total laryngectomy could not be avoided. In all cases of T2 cancers of the glottic and subglottic level a definite resection was possible. Follow-up investigations showed 3 recurrences in the larynx so far. These were treated by laryngectomy. Recurrences in the cervical nodes were seen in two patients following resection of a supraglottic and a subglottic tumor. The authors believe that laser surgery may obviate the need for total laryngectomies in certain stages of laryngeal cancer, especially in T2 tumors. T3 tumors should not be treated by endolaryngeal laser surgery. At present, the number of recurrences and the rate of survival show no significant difference to those after conventional surgery. The phonatory function is not always predictable, and still needs to be investigated.     

CO2激光在声门型喉癌外科治疗中的应用

目的 分析CO2激光治疗声门型喉癌的适应证、手术要点和并发症的预防.方法 回顾性分析复旦大学附属眼耳鼻喉科医院2003年3月至2006年6月间应用CO2激光治疗的60例无转移的声门型喉癌(T1期52例和,12期8例)的疗效和手术并发症.结果 所有病例术后声音嘶哑都比较明显,随着患侧声带切除后的逐渐修复,发音逐渐响亮,1年左右接近正常发音或轻度嘶哑.术后无气管切开、误吸和呼吸困难患者,除2例双侧声带癌行双侧声带切除后发生前连合粘连外,无其他严重并发症.60例喉癌病例中,54例术后随访2～5年无瘤生存.术后复发4例,1例再次激光手术,随访至今2年无瘤生存;3例改为喉全切除术,其中1例随访2年无瘤生存,2例再次复发死亡.术后4年和5年各失访1例.以Kaplan-Maier法统计累积生存率,3年和5年生存率分别为100.0%和91.5%.结论 激光作为一种微创技术,在喉癌的外科治疗中具有广泛的应用前景.激光手术创伤小,出血少,恢复快,疗效好,且能保留较为满意的发音功能,是治疗T1、T2声门型喉癌的理想方法,值得推广.     

Pathological examination of cordectomy specimens: analysis of negative resection

Objective

Occasionally, after performing a cordectomy to treat a T1 glottic tumor, the pathologist does not detect carcinomatous cells in the surgical specimen. This study determined how often this happens and analyzed these cases to identify related variables.

Methods

Forty-six patients were studied. Data on patient age and gender, tumor T stage and macroscopic surface extension, device used (laser vs. microelectrode dissection (ME)), and presence/absence of a negative cordectomy were compiled. We performed excisional biopsies as a diagnostic procedure.

Results

Tumor stage was carcinoma in situ (Cis; 11 cases), T1a (28 cases), or T1b (7 cases). Nineteen tumors were limited, and 27 were extensive. Twenty-one patients underwent laser surgery, and 25 had ME. There were 12, 21, 4, and 9 types II to V cordectomies, respectively. The pathologist reported 15 negative cordectomies (32.6%). Only tumor extension was significantly associated with a negative cordectomy (p = 0.047).

Conclusion

In 32.6% of our cases, the excisional biopsy was diagnostic and therapeutic. This percentage rose to 52.6% in the cases of limited tumors. We recommend performing an excisional biopsy and limited resection of the surgical bed with ME or laser surgery. A pathologist can examine the margins to determine whether the resection should be extended. When choosing radiotherapy, it is better to first perform an incisional biopsy to obtain a diagnosis of carcinoma.     

Transoral robot-assisted CO2 laser supraglottic laryngectomy: experimental and clinical data

BACKGROUND: Transoral CO2 laser surgery for selected supraglottic tumors results in improved postoperative function and decreased morbidity, with comparable survival to open surgery. Recently, robot-assisted techniques have been reported for the management of supraglottic lesions. There are no reports in the English literature of robotic technology coupled with CO2 laser technology. Our objective was to report the use of such technology. STUDY DESIGN: Experimental resection of the supraglottis in a cadaver and a dog model using a commercially available surgical robot coupled with CO2 laser technology. Initial human experience with such technology is reported. METHODS: With use of a hollow core fiber that allows the transmission of CO2 laser energy linked to the daVinci Surgical Robot, a supraglottic laryngectomy was performed in an edentulous female cadaver. The FK Laryngo-Pharyngoscope was used for exposure. In a second experiment, a supraglottic partial laryngectomy was performed in an 80 pound dog. On the basis of our experimental experience, a CO2 laser robotic-assisted supraglottic laryngectomy was attempted in three patients. RESULTS: Removal of the supraglottic larynx in both a cadaver and canine experimental models was believed to be satisfactory using this technology. Bleeding was easily controlled in the live canine model. A 74-year-old woman with a large supraglottic mass for which she had been offered a total laryngectomy was resected successfully with this technology. The FK Laryngo-Pharyngoscope provided excellent exposure. The patient was able to swallow without difficulty on postoperative day 5. Follow-up endoscopic examination at 1 month showed no evidence of residual laryngeal tumor. Robot-assisted procedures were attempted in two additional patients, but adequate exposure could not be achieved, and more traditional techniques were performed. CONCLUSIONS: The use of the daVinci Surgical robot coupled with CO2 laser technology is feasible, as demonstrated by our experimental and clinical data. Although further development of the robotic technology is required at present, the use of robotics coupled with CO2 laser technology may have important implications in the management of supraglottic laryngeal cancer in the future.     

CO2激光喉显微手术治疗早期声门型喉癌疗效观察及相关因素分析

目的探讨CO2激光喉显微手术治疗早期声门型喉癌的疗效和安全性,对手术注意事项进行探讨。方法在显微支撑喉镜下,对27例早期声门型喉癌患者采用CO2激光手术治疗,其中Tis6例,T1a8例,T1b7例,T26例。累及前联合者3例,未累及前联合者24例。结果全部患者CO2激光手术均成功,术后无一例患者出现呼吸困难、出血等严重并发症。随访3年以上,存活率100％。2例患者复发,其中1例行CO2激光喉显微手术再切除,1例行喉垂直部分切除并术后放疗,随访2年均未再复发。结论CO2激光喉显微手术是治疗早期声门型喉癌的有效方法,通过选择合适的患者及注意术中操作,可减少甚至避免显微喉镜激光手术引起的声带粘连。     

Oncological results of endoscopic resections of Tis and T1 glottic carcinomas by carbon dioxide laser

A cohort of 88 patients with glottic cancer (13 Tis, 75 T1) who underwent endoscopic CO2 laser excision between January 1995 and June 1997 was prospectively studied. The mean follow-up was 43 months (range, 30 to 60 months). The depth and extent of the excision (graded according to the European Laryngological Society Classification, which includes 5 types of resection) were based on the results of a preoperative and intraoperative diagnostic test battery. Five patients died of other diseases, and none of glottic cancer. Of the 12 patients who developed a local recurrence, 5 underwent a second endoscopic procedure, 5 a total laryngectomy, and 1 a supracricoid laryngectomy, and 1 was treated with radiotherapy. The 5-year local control rate with endoscopic surgery alone, according to the Kaplan-Meier method, was 91%. None of the variables (8 related to the tumor and 2 to the treatment) tested in a univariate analysis by the log-rank test was found to have a significant impact on disease-free survival rates. The present study confirmed that endoscopic partial cordectomy for Tis and T1 glottic cancers can be regarded as a valid alternative to radiotherapy in terms of oncological results.     

Endolaryngeal cordectomy using cold instruments for treatment of T1 glottic cancers

In the treatment of early-stage glottic cancers, radiotherapy and surgery have similar success rates. In our department, we have been using cold instruments coupled with surgical microscope and/or telescopes for several years in treatment of early stage glottic cancers. Our aims were, to present our experience with endolaryngeal resection of T1 glottic cancers with cold instruments coupled with surgical microscope and telescopes, to present our oncological results, to discuss the advantages of endolaryngeal cordectomy over open cordectomy or RT and to discuss whether laser is obligatory for this approach or not.Our study includes retrospective analysis of 38 patients with T1 glottic cancer, who have been treated with endolaryngeal surgery as the primary treatment. The median follow-up was 24 months. The most commonly performed procedure was type-II cordectomy (38.5%). Overall survival rate was 94.7%, while the disease-specific survival rate was 100%. Local recurrences occurred in two patients at 8th and 11th months, postoperatively. In the first patient, type-Vc cordectomy and in the second type-Va cordectomy had been performed. Both patients with recurrences could be salvaged by fronto-lateral laryngectomy, and are still alive in their 38th and 6th months following salvage surgery. Therefore, the local control rate and larynx preservation rate with endolaryngeal cordectomy were 94.7 and 100%, respectively, in this study group. All patients had a voice quality sufficient for communicating easily over telephone. We believe that lasers are not obligatory to perform endolaryngeal cordectomy for treatment of T1 glottic cancers, as the same oncological and similar functional outcomes may be achieved with the traditional cold instruments.     

Recurrence after removal of a vocal cord for laryngeal fissure

The evolution of 39 patients undergoing cordectomy by laryngofissure between 1980 and 1995 was analyzed. All patients were male. There were 33 (84.6%) T1a and 6 T1b (15.4%). Cause specific survival at 3, 5 and 10 years was 92.3, 89.7 and 89.7%, with an overall survival of 89.7, 84.3 and 65.8% at 3, 5 and 10 years respectively. Positive margins were found in two patients. Local recurrences were present in 4 patients (10.2%), loco-regional in 1 patient (2.5%), and paratracheal in 1 patient (2.5%). Salvage therapy included total laryngectomy in four patients (10.2%) and partial surgery in one patient. Correct evaluation of tumor extension and adequate free margin analysis are the essentials to avoid local recurrence after cordectomy, a well establish option for treatment of early glottic carcinoma.     

Local recurrence after CO2 laser cordectomy for early glottic carcinoma

OBJECTIVES: To point out prognosis factors of local recurrence after endoscopic cordectomies for Tis, T1a, T1b, and T2 glottic squamous cell carcinomas. STUDY DESIGN: A cohort of 110 patients treated from January 1990 to December 2000 at a single institution was retrospectively analyzed: 21 had Tis, 76 T1a, 7 T1b, and 6 T2 (mean follow-up 42 mo; range 1-160 mo). METHODS: The depth and extension of the excision were graded according to the European Laryngological Society Classification. Univariate analysis was used to review the impact on disease-free survival of factors related to the host, the tumor, and the treatment. RESULTS: According to the Kaplan-Meier method, the 5 year overall survival and the disease-free survival were 87% and 75%, respectively. The rates of cause-specific survival, ultimate local control with laser alone, and laryngeal preservation were 97%, 84%, and 90%, respectively. Univariate analysis by the log rank test revealed that vocal muscle infiltration (P = .001) and subglottic involvement (P = .02) have a significant impact on disease-free survival. Of the 22 patients with local recurrence (17 T1a, 1 T1b, and 4 T2), 9 were managed with total laryngectomy, 5 with partial laryngectomy, 4 with further laser cordectomy, 2 with radiotherapy, and 2 had no curative treatment. CONCLUSION: Transoral laser surgery for early glottic carcinoma is a valid alternative to radiotherapy and partial laryngectomy in terms of oncologic results. It offers low morbidity and excellent retreatment options in case of local failure. Careful patient selection for laser surgery is essential to secure good results.     

Is frozen section reliable in transoral CO2 laser-assisted cordectomies?

Endoscopic resection of laryngeal tumors is replacing external approaches. One drawback of endoscopic resection is the difficulty of interpretation of histological specimens because of thermal effect of laser on tissues. Our goal is to assess the reliability of frozen section in this setting by comparing its results with those of routine histology. We, retrospectively, reviewed the charts of all consecutive patients, who underwent cordectomies in our institution between January 2000 and 2008, using the CO₂ laser Acublade system (Lumenis, Santa Clara, CA). Age, sex, staging of the tumor, previous treatments, type of cordectomy, frozen section and routine histology results were analyzed. Ninety-seven patients fulfilled the inclusion criteria; 22.7% had severe dysplasia, 54.6% had T1 epidermoid carcinoma, 17.5% had T2 carcinoma and finally 5.2% had T3 carcinoma. We performed type I cordectomy in 36.1% of patients, type II cordectomy in 18.6%, type III cordectomy in 10.3%, type IV cordectomy in 5.2%, type V cordectomy in 28.9% and type VI cordectomy in 1% of patients. Most of the patients did not have any previous treatment. The mean number of margins per surgery was 2. Routine histological examination confirmed frozen section in 94.8% of the interventions. Frozen section is reliable in laser-assisted cordectomies, when performed by an experienced team; it has a high negative-predictive value. It can limit the need, cost and emotional stress of second look surgeries.     

喉癌患者喉部分切除术后的嗓音声学分析

目的 探讨喉癌患者喉部分切除术术式、喉功能重建方法与术后嗓音质量的关系。方法 采用Dr．Speech嗓音分析软件，对116例不同术式喉部分切除术患者分别于术后1、2年进行发声功能测试，对测得的基频微扰（jitter）、振幅微扰（shimmer）、标准化噪声能量（NNE）进行比较分析，判断受试者嗓音质量。结果 所测得的声学参数jitter、shimmer、NNE值，以喉声门上水平部分切除术组最低，嗓音质量相对最好（P〈0．01）；喉次全切除术组最高，嗓音质量相对最差（P〈0．01）。声带切除术组和声带癌激光切除术组与其它各组比较，其差异均有显著统计学意义（P〈0．05或0．01），但这两组间比较，差异无统计学意义。各组术后嗓音质量效果从好到差依次为：喉声门上水平部分切除术组、声带切除术组、声带癌激光切除术组、喉垂直部分切除术组、喉额侧部分切除术组、喉次全切除术组。结论 喉癌患者喉部分切除术后，发声功能的恢复与手术方式及重建方法密切相关，其中，喉声门上水平部分切除术组术后嗓音质量相对最佳，喉次全切除术组术后相对最差。     

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

目的 探讨经口内镜下CQ激光手术治疗的Tis、T1、T2期声门型喉癌患者术后复发的相关因素.方法 回顾性分析在安徽省立医院接受经口内镜下CO2激光治疗的180例Tis～T2期声门型喉癌患者的临床资料,其中Tis 22例,T1a 90例,T1b 32例,T2 36例;以肿瘤复发为终点,运用单因素及多因素方法分析年龄、性别、肿瘤T分期、手术方式、病理分级、声带运动、前联合是否受累等因素对复发率的影响.结果 Tis患者的复发率为9.09％(2/22),T1a患者的复发率为13.33％(12/90),T1b患者的复发率为18.75％(6/32),T2患者的复发率为38.89％(14/36);Ⅰ型手术患者术后复发率为0,Ⅱ型手术患者术后复发率为3.57％(1/28),Ⅲ型手术患者术后复发率为15.0％(9/60),Ⅳ型手术患者术后复发率为19.60％(10/51),Ⅴ型手术患者术后复发率为36.84％(14/38).不同肿瘤T分期及不同手术方式患者复发率之间差异有显著统计学意义(P=0.006);单因素Logistics回归分析示T2期(OR=6.36,P＜0.05)及手术方式(OR=2.06,P＜0.05)与术后复发率显著相关,多因素Logistics回归分析手术方式(OR=1.71,P＜0.05)是术后复发率的独立影响因素.结论 声门型喉癌复发率与T分期及手术方式密切相关,随着T分期及手术等级的增高患者复发率随之升高,手术方式是术后复发的独立危险因素.     

光纤CO2激光在经口机器人手术中的应用：4例恶性肿瘤患者的可行性分析

本研究进行新型光纤C02激光（CO2 laser wave guide，LWG）机器人外科手术（transoral robotic surgery，TORS）可行性分析，纳入年龄大于18岁的恶性头颈肿瘤患者共4例。分别患T1期舌底癌，T1及T2期声门上型喉癌，扁桃体癌，平均年龄56岁，400均已签署知情同意书。手术器械包括马里兰分离钳，0°内镜，光纤CO2激光机器人手术臂。激光参数如下：超脉；中或连续波模式，功率7～15W，连续曝光，平均准备时间30min，平均手术时间94min，每台手术使用一根光纤，平均组织凝固深度200μm（范围：100-300μm）。术中均未出现并发症，平均住院时间6d。光纤CO2激光对于机器人外科手术是一个可靠引导工具，它可使手术时间缩短1h有余而不带来负面后果。