早期声门型喉癌患者CO2激光术后声带粘连的相关因素分析

目的 探讨早期声门型喉癌患者CO2激光术后声带粘连的相关因素.方法 回顾性分析51例行CO2激光手术治疗的早期声门型喉癌患者的临床资料,对其中发生声带粘连者其声带粘连与手术类型、肿瘤T分期、前联合是否受侵犯和术后是否出现肉芽等因素的相关性进行分析.结果 51例患者中,术后发生声带粘连23例,占45.10％(23/51),其中按手术分型:Ⅱ型1例(12.50％,1/8),Ⅲ型2例(22.22％,2/9),Ⅳ型6例(50％,6/12),Ⅴ型14例(63.64％,14/22),各型间差异有统计学意义(x2校正=9.17,P＜0.05);按肿瘤T分期:Tis2例(14.29％,2/14),T1a12例(46.15％,12/26),T1b 3例(100％,3/3),T2 6例(75％,6/8),不同分期间差异有统计学意义(x2校正=13.84,P＜0.05);前联合受侵犯9例(56.25％,9/16),前联合未侵犯14例(40％,14/35),两者差异无统计学意义(x2=1.171,P＞0.05);喉内高出声带表面肉芽25例(49.02％,25/51),其中8例因单一肉芽因素导致声带粘连,占32％(8/25).结论 早期声门型喉癌患者CO2激光手术后声带粘连与手术类型、肿瘤T分期及术后肉芽增生有关.     

CO2激光手术治疗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1992年8月～1998年4月激光手术治疗的217例声门型喉癌进行临床分析.217例中原位癌(Tis) 22 例,T1a病变108 例,T1b病变38例,T2病变46例,T3病变3例.术后随诊3～9年.结果 217例支撑喉镜下CO2激光手术后21例局部复发,局部复发率为9.7%(21/217).T1a复发率5.6%(6/108), T1b复发率21.1%(8/38),T2复发率13.0%(6/46),T3复发率(1/3),组间差异有显著性 (χ2值=6.102,P<0.01).病变侵犯前联合复发率21.6%(13/60),病变未侵犯前联合复发率5.1%(8/157),两组间差异有显著性 (χ2值=13.64,P<0.01).217例激光手术治疗的患者,201例存活,失访4 例(按死亡计算),死亡12例.3年生存率97.2%(211/217),5年生存率89.4%(118/132).结论激光手术治疗早期声门型喉癌疗效可靠,喉功能保全好,并发症的发生率低.     

226例声门型喉癌预后及影响因素分析

目的分析影响外科治疗声门型喉癌患者的预后及其影响因素。方法2008年6月—2013年4月首诊并行手术治疗的声门型喉癌患者226例的临床资料,分析患者的性别、年龄、T分期、N分期、手术方式、术后放疗、病理分级可能与喉癌预后相关的指标;单因素分析采用Log rank检验,多因素分析采用Cox比例风险回归模型,5年生存率采用Kaplan-Meier 法计算。结果①单因素分析显示年龄、T分期、N分期、病理分级、术后放疗、术后局部复发、术后颈部淋巴结复发与声门型喉癌预后相关(P＜0.05);②多因素分析显示年龄、T分期、N分期、术后咽喉部/造瘘口复发、术后颈淋巴结复发是影响声门型喉癌患者预后的独立危险因素(P＜0.05);③声门型喉癌患者5年总体生存率75.2%。结论合理的颈部淋巴结清扫和术后放疗可以提高局部晚期声门型喉癌的疗效;III、IV期患者术后局部/颈淋巴结复发风险高,需要密切随访,积极的挽救性手术仍是患者复发后主要的治疗方法。     

CO2激光手术治疗早期声门型喉癌疗效分析

目的：探讨经口内镜下CO2激光显微外科手术治疗早期声门型喉癌的疗效。方法：回顾性分析1999年10月～2004年8月接受CO2激光显微外科手术治疗声门型喉癌患者91例（Tis9例,pT1a45例,pT1b25例,pT212例）。声带切除方式按2000年欧洲喉科学会制定分类方案划分。结果：依照Kaplan-Meier方法计算5年局部无复发率：Tis100．00％,T1a93．33％,T1b84．00％,T275．00％,组间差异无统计学意义（P〉0．05）。病变侵犯前联合5年局部无复发率78．57％（6／28）,未侵犯前连合5年局部无复发率93．65％（4／63）,组间差异有统计学意义（χ2=4．348,PdO．05）。5年整体生存率92．72％,无瘤生存率84．62％。术后6个月GRBAS声音嘶哑评估：Ⅰ、Ⅱ型术后评分正常或轻度异常水平;Ⅲ、Ⅳ、Ⅴ型手术术后嗓音大部分有轻度至中度嘶哑音。结论：CO2激光显微外科对治疗早期声门型喉癌是有效的治疗方法。     

CO2激光治疗早期声门型喉癌的meta分析

目的:应用meta分析的方法对CO2激光治疗早期声门型喉癌不同分期(Tis、T1N0M0、T2N0M0)的疗效进行评价。方法:检索万方期刊库、中国期刊网(清华同方)、中国科技期刊库(重庆维普)、PubMed、EM-BASE、OVID、PML(Proquest Medical Library)数据库中的杂志、学位论文等。制定严格的纳入和排除标准,对相关文献进行筛查、质量评价和资料提取。对符合入选标准的资料运用RevMan 5.0软件进行meta分析。在进行异质性检验后选择适当的统计模型,进行资料合并,以Tis、T1N0M0、T2N0M0期声门型喉癌CO2激光术后复发率为观察指标,对比CO2激光治疗早期声门型喉癌的疗效。结果:经筛选,有27篇国内外文献符合循证分析的要求,对其进行meta分析。Tis组和T1组相比差异无统计学意义(P<0.05);T1a组和T1b组相比差异有统计学意义(P<0.01);T1组和T2组相比差异无统计学意义(P<0.05);前联合受累组和前联合阴性组相比差异有统计学意义(P<0.05)。结论:应用CO2激光治疗早期声门型喉癌时,不同的分期对术后复发率有不同程度的影响,Tis期与T1期及T1期与T2期术后复发率无明显差异,T1a期术后复发率低于T1b期,前联合受累组术后复发率高于对照组。     

早期声门型喉癌CO_2激光手术治疗CSCD

目的总结探讨在支撑显微喉镜下通过CO2激光微创手术治疗早期声门型喉癌的疗效。方法对2007年1月~2012年12月于福建省立医院耳鼻咽喉头颈外科接受CO2激光手术治疗的91例早期声门型喉癌患者进行回顾性分析。结果全部患者CO2激光手术后随访25~96个月,2例患者失访(视为死亡),1例患者于术后81个月死于肺癌,喉功能保留率为96.70%(88/91);10例患者出现局部复发,复发率为11.00%(10/91),T1a复发率为12.12%(4/33),T1b复发率为9.10%(3/33),T2复发率为20.00%(3/15),组间差异无统计学意义(χ2=2.645,P>0.05)。前连合受累患者的复发率为28.57%(6/21),前连合未受累的患者复发率为5.71%(4/70),两组比较差异有统计学意义(χ2=8.628,P<0.05)。5年整体生存率为93.20%,局部区域(喉+颈部淋巴结)5年控制率(无肿瘤复发和转移的比率)86.70%。结论支撑喉镜下CO2激光治疗早期声门型喉癌的疗效可靠,创伤小,喉功能保全好,恢复快,并发症少,值得临床推广应用。     

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8961例声门型喉癌进行临床分析。61例中,T1a33例,T1b16例,T212例。累及前联合者12例,未累及前联合者49例。术后随诊12～73个月。结果61例支撑喉镜下C02激光手术后5例局部复发,1例T2患者术后7个月出现同侧颈淋巴结转移,局部（区域）复发率为9．8％（6／61）。T1a复发率3．0％（1／33）,T1b复发12．5％（2／16）,T2复发率25．0％（3／12）,组间差异有显著性（Χ^2=4．836,P〈0．05）。病变侵犯前联合复发率16.7％（2／12）,病变未侵犯前联合复发率8．2％（4／49）,两组间差异无显著性（Χ^2=0．697,P〉0．05）。61例激光手术治疗的患者,58例存活,死亡3例。结论激光手术治疗早期声门型喉癌疗效可靠,喉功能保全好,是早期喉癌理想的治疗方式。     

二氧化碳激光治疗累及前联合的早期声门型喉癌的疗效分析

目的探究CO2激光声带切除术对于累及前联合的早期声门型喉癌的疗效。方法回顾性分析我院60例接受CO2激光治疗的累及前联合的早期声门型喉癌患者的临床资料,并运用GRBAS量表中的G评分对术后6月内未复发的患者进行嗓音评估。结果所有患者术后随访12~72个月,其中局部复发10例,复发率16.6%(10/60),其中T1a复发率9.5%(2/21),T1b复发率16.0%(4/25),T2复发率28.5%(4/14)。根据手术时间顺序,前30例患者总体复发率23.3%(7/30),后30例患者总体复发率10.0%(3/30)。接受嗓音评估的患者中,G评分在0~2分内的共有54例。结论CO2激光手术对于累及前联合的早期声门癌而言,T1a具有很好的疗效,T1b为其适应症,T2选择需谨慎,总体患者术后嗓音质量良好。     

早期声门型喉癌的CO_2激光手术治疗

目的：探讨CO2激光手术治疗声门型喉癌的临床治疗效果。方法：112例声门型喉癌患者均在全身麻醉下经口气管插管,用支撑喉镜充分暴露声门,完全看清肿瘤后,显微镜下用CO2激光沿肿瘤外缘切除声门肿瘤,安全边界为3~5mm。术后随诊12~62个月。结果：112例支撑喉镜下CO2激光手术后8例局部复发,局部复发率7.14%,T1a复发率0.89%、T1b复发率0.89%、T2复发率5.40%,组间差异有统计学意义（χ2=5.306,P〈0.01）。病变侵犯前连合复发率7.14%,病变未侵犯前连合复发率7.14%,2组差异无统计学意义（χ2=0.000,P〉0.01）。1例患者术后当天出现喉腔大出血,经再次手术,应用带吸引单极电凝止血成功。结论：激光手术治疗早期声门型喉癌疗效可靠,喉功能保全好,是早期喉癌较为理想的治疗方式。     

喉额侧窗式切除术治疗侵及前联合的T1b期声门型喉癌疗效分析

目的 探讨喉额侧窗式切除术结合甲状软骨外膜瓣修复术治疗侵及前联合的T1b期声门型喉癌的疗效.方法 对确诊为前联合受侵的T1b期声门型喉癌患者22例,均行喉额侧窗式切除术结合甲状软骨外膜瓣修复术治疗;随访5年,观察患者术后呼吸功能、吞咽功能、发音功能、复发率及生存率.结果 所有患者手术均顺利完成,术后二周拔除气管套管,拔管率100％;无一例发生误咽;术后患者发声功能(G分级)较术前改善者为86.4％(19/22),与术前相同者为13.6％(3/22);肿瘤复发2例,1例为原位复发,1例为颈部淋巴结转移复发,复发率为9.1％(2/22);5年生存率为95.5％(21/22).结论 喉额侧窗式切除术结合甲状软骨外膜瓣修复术式适用于前联合受侵的T1b期声门型喉癌,该术式能相对完整地保留喉的骨架及生理功能,不易引起喉狭窄,且修复组织稳定,能有效改善发声质量.     

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.     

CO2激光治疗声门型喉癌远期疗效分析

目的 探讨显微支撑喉镜下CO₂激光治疗声门型喉癌的远期治疗效果。 方法 对声门型喉癌患者106例,采用显微支撑喉镜下CO₂激光治疗,回顾性分析病历资料。其中T_isN₀M₀ 4例、T_1aN₀M₀ 62例、T_1bN₀M₀ 16例、T₂N₀M₀ 22例、T₃N₀M₀ 2例。 结果 106例患者手术顺利,无严重并发症发生。术后死于复发或颈部转移4例,死于意外4例,死于远处转移2例,失访4例,术后局部复发者再次手术后至今良好2例。目前92例仍存活,无肿瘤复发,生活质量良好。3年、5年和10年生存率分别为98.7%、95.2%和89.0%,总局部复发率为5.7%。 结论 显微支撑喉镜下CO₂激光手术是治疗T_is、T_1a声门型喉癌的首选方法,手术创伤小,术后恢复快,喉功能保全好,远期生存率高;该手术对于经过精心选择的声门型T_1b和T₂、T₃喉癌也有较好的临床疗效。     

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.     

Vocal outcome after endoscopic cordectomies for Tis and T1 glottic carcinomas

A cohort of 101 patients with previously untreated glottic cancer (15 Tis, 66 T1a, and 20 T1b) who underwent endoscopic CO2 laser excision between January 1995 and December 1997 was prospectively analyzed. The depth and extension of the excision were graded according to the European Laryngological Society Classification including 5 types of cordectomy. All patients were subsequently examined every 2 months for a period ranging from 30 to 66 months (mean, 48 months). The rates of 5-year overall survival, disease-free survival, ultimate local control with laser alone, and laryngeal preservation were 85%, 87%, 93%, and 95%, respectively. Sixty-nine patients underwent, at least 1 year after surgery, videolaryngostroboscopy combined with perceptual and objective evaluation of the voice, and spirometry. Acoustic parameters were compared with those obtained in a matched control group by Kruskal-Wallis test. No statistically significant difference was found (p > .05) between patients submitted to subepithelial (type I) and subligamental (type II) cordectomies and controls.     

CO2 laser cordectomy for early-stage glottic carcinoma: a long-term follow-up of 156 cases

OBJECTIVES: To define when laser resection of early-stage glottic carcinoma is indicated and to compare the results obtained by laser surgery with other therapeutic options. STUDY DESIGN: Retrospective study of 151 patients treated from April 1982 to June 1996 in the Department of Otorhinolaryngology at "La Sapienza" University. We provide analysis of indications, techniques, and oncologic results of this study. METHODS: Glottic tumors were treated with type III, type IV, and type Va cordectomies according to the classification of endoscopic cordectomies proposed by the European Laryngological Society in 2000. RESULTS: The results are summarized as follows: all patients with carcinoma in situ Tis are free of disease with local control rate at 3 years of 100%; 2 died of other causes without evidence of local recurrence with an overall survival rate at 3 years of 83.2%. Of the 117 patients with stage T1a cancer, 110 are free of disease at 3 years with local control rate of 94%; 4 patients died of other causes without evidence of local recurrence with an overall survival rate of 96.5%. Of the 22 patients with stage T1b cancer, 20 are free of disease at 3 years with a local control rate of 91%; 1 patient died of other causes without evidence of local recurrence with an overall survival rate at 3 years of 95.4%. CONCLUSIONS: According to our experience, we can conclude that endoscopic laser surgery is an efficacious and cost-effective treatment for early stage glottic cancer.     

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.     

CO2激光手术治疗喉癌的并发症分析

目的 总结CO2激光手术治疗喉癌的并发症发生情况,分析影响并发症发生的相关因素,并提出相应的预防措施.方法 总结分析北京同仁医院耳鼻咽喉头颈外科1992年8月至2008年12月激光手术治疗的912例喉癌患者临床资料.声门上型喉癌35例,声门型喉癌877例,声门型喉癌中原位癌(Tis)53例,T1 659例,T2 158例,T3 7例.术后随访2～18年,中位随访时间9.3年.结果 912例患者中,824例存活,失访29例(按死亡计算),死亡59例.直接法统计总的局部复发率为9.4%(86/912),3年生存率95.6%(775/811),5年生存率87.9%(518/589).83例(9.1%)出现手术相关并发症,其中声门上型喉癌中并发症发生率17.1%(6/35),声门型喉癌8.8%(77/877),两组差异无统计学意义(χ2=2.85,P＞0.05).声门型喉癌中,原位癌并发症发生率为5.7%(3/53),T1为7.8%(51/659),T2为13.3%(21/158),T3为28.6%(2/7),组间差异有统计学意义(χ2=8.97,P＜0.05＝.病变侵犯前联合的并发症发生率为12.8%(31/242),未侵犯前联合为7.2%(46/635),组间差异有统计学意义(χ2=6.78,P＜0.05＝.Ⅱ型手术患者并发症发生率为3.8%(4/105),Ⅲ型为7.0%(20/287),Ⅳ型为9.7%(22/226),Ⅴ型为12.0%(31/259),组间差异有统计学意义(χ2=7.96,P＜0.05＝.结论 全麻下显微喉镜激光手术治疗喉癌在术中、术后存在潜在风险和并发症,并发症的发生与原发肿瘤的部位范围和手术切除的范围和深度有关,需要采取积极的预防措施.

Abstract：

Objective To evaluate the complications of CO2 laser surgery in the treatment of laryngeal carcinoma,to analyze related factors and to propose preventive measures.Methods Retrospective analysis of 912 cases of laryngeal carcinoma(35 cases of supraglottic cancer and 877 cases of glottic cancer)treated only with laser surgery in Tongren Hospital was carried out.Among the glottic cancer,carcinoma in situ (Tis),T1,T2 and T3 were 53,659,158 and 7 cases.The follow-up period ranged from 2 to 18 years,with a median follow-up time of 9.3 years.Results Of 912 cases,824 cases were still alive,29 cases failed to be followed-up(taken into dead number),and 59 cases were dead.The recurrent rate was 9.4%(86/912).Three year survival rate was 95.6% (775/811)and five year survival rate was 87.9%(518/589).The incidence of surgery complications was 9.1% (83/912).Incidence of complications in supraglottic carcinoma and glottic carcinoma were 17.1% (6/35) and 8.8% (77/877),respectively,with no difference between the two groups (χ2 = 2.85,P ＞ 0.05).Incidence of complications of Tis,T1,T2 and T3 cases of glottic cancer were 5.7% (3/53),7.8% (51/659),13.3% (21/158) and 28.6% (2/7)respectively,with significant difference (χ2 = 8.97,P ＜ 0.05).Incidence of complications of glottic carcinoma with and without anterior commissure indision were 12.8% (31/242) and 7.2% (46/635)respectively,with significant difference between the two groups (χ2 = 6.78,P ＜ 0.05) .Incidence of complications in the patients underwent type Ⅱ ,Ⅲ,Ⅳ,Ⅴ cordectomy were 3.8% (4/105),7.0%(20/287),9.7% (22/226) and 12.0% (31/259) respectively,with significant difference (χ2 =7.96,P ＜0.05).Conclusions There are some potential risks and complications intra- and post-operatively,according to the sites and extent of the primary tumors and the range and depth of removed tissues.It needs to take active preventive measures to reduce the incidence of complications.     

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.     

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.