CO2-laser treatment of recurrent glottic carcinoma

The records of 23 patients treated by CO₂-laser surgery for recurrent glottic carcinoma after radiotherapy were studied retrospectively to assess treatment results and complications. 15 patients (65%) were cured with one or more laser procedures. The remaining 8 underwent a total laryngectomy for a second or third recurrence. One patient (4%) died of disease. No major complications from C0₂-laser surgery were encountered. It is concluded that C0₂-laser surgery is a safe method of treatment of recurrent glottic carcinoma.     

高频电刀治疗声门型喉癌的手术方法及预后

目的：探讨高频电刀治疗声门型喉癌的手术方法及预后。方法：对20例声门型喉癌患者,应用高频电刀在皿微支撑喉镜下行声带切除术。结果：所有患者术后随访5个月～6年,喉功能和结构保留良好;1例术后半年局部复发,再行全喉切除术,随访5年未见复发;其余19例（其中2例声带前段轻度粘连）未见局部复发和淋巴结转移。结论：在全身麻醉最微支撑喉镜下,应用高频电刀行声门型喉癌切除手术,疗效较好,且无需投入昂贵设备。     

Radiotherapy. The mainstay in the treatment of early glottic carcinoma

Early squamous cell carcinoma of the glottis may be effectively treated with surgery or radiation therapy. Controversy exists as to whether radiation therapy effects survival at the expense of vocal function by ultimately requiring more total laryngectomies for salvage of local tumor recurrence. This study reviewed the medical records of 185 patients with T1 or T2, NO invasive squamous cell carcinoma of the glottis treated with primary radiation therapy between 1969 and 1984. All patients were followed up for a minimum of 5 years after completion of therapy. One hundred sixty-one patients met the criteria for local control analysis. Radiation therapy controlled disease in 93% (105 of 113) of patients with T1 lesions and 73% (38 of 48) of those with T2 tumors. Ultimate control of disease for T1 and T2 lesions, including surgical salvage, was 111 (98%) of 113 and 44 (92%) of 48 patients, respectively. The rate of successful surgical salvage was 75% (T1) and 70% (T2). The T2 lesions with impaired vocal cord mobility or anterior commissure disease were identified as being at increased risk for recurrence after primary radiation therapy. Overall voice preservation was 90%. Our data demonstrate that radiation therapy effects disease-free survival rates that are comparable to those produced by surgery, without sacrificing voice. Although a small percentage of patients with selected early glottic lesions may be more effectively treated with primary conservation surgery, these data do not support a change in philosophy concerning primary treatment of early glottic cancer with radiation therapy.     

CO2-laser treatment of recurrent glottic carcinoma.

The records of 23 patients treated by CO2-laser surgery for recurrent glottic carcinoma after radiotherapy were studied retrospectively to assess treatment results and complications. 15 patients (65%) were cured with one or more laser procedures. The remaining 8 underwent a total laryngectomy for a second or third recurrence. One patient (4%) died of disease. No major complications from CO2-laser surgery were encountered. It is concluded that CO2-laser surgery is a safe method of treatment of recurrent glottic carcinoma.     

环状软骨舌骨会厌固定术治疗声门型喉癌远期疗效观察

目的 分析并探讨应用环状软骨舌骨会厌固定术( cricohyoidoepiglottopexy,CHEP)治疗声门型喉癌术后喉功能恢复及并发症的发生情况,评估患者的预后.方法 回顾性分析1990年1月至2008年12月上海仁济医院耳鼻咽喉头颈外科施行CHEP手术的患者共92例.肿瘤分期为Ⅰ期41例,Ⅱ期39例,Ⅲ期12例.以Kaplan-Meier法进行生存率分析,并结合术后气管套管放置天数、胃管拔除时间以及发音情况反映功能恢复结果.结果 26例患者共27侧行颈淋巴清扫术,淋巴结阳性率为11.1％(3/27),手术切缘均阴性,术后7例患者接受放疗,1例患者接受放疗同时辅以化疗.本组92例患者中共有13例(14.1％)发生局部复发,9例(9.8％)发生术后局部淋巴结以及远处转移.手术后3年、5年、10年生存率分别为90.0％、84.5％、67.0％.将生存时间同性别、T分期、病理N分期、肿瘤分期、是否术后放化疗、是否复发等不同因素以及不同年龄组比较Cox相关性分析认为,肿瘤复发是最为重要影响因素.结论 环状软骨舌骨会厌固定术是一种操作较易掌握、效果较为理想的声门型喉癌治疗手段.     

原发于声带后联合的声门型喉癌的手术治疗

目的 探讨治疗原发于声带后联合的恶性肿瘤的手术方式及预后.方法 总结原发于声带后联合的恶性肿瘤患者8例,其中3例TisN0 M0在支撑喉镜下手术切除;3例T1M0N0、2例T2 N0 M0常规行患侧Ⅱ、Ⅲ、Ⅳ区淋巴结清扫,部分喉切除,创面用带蒂胸骨舌骨肌肌瓣修复.结果 术后2例患者病理证实患侧颈部淋巴结转移.8例患者术后均顺利拔管,有较好的发音和吞咽功能.随访5年,3例复发,其中1例死亡.结论 原发于声带后联合的声门型喉癌,相对于一般声门型喉癌,复发率和颈部淋巴结转移率明显偏高,对于非原位癌的患者最好能同期行同侧颈廓清术.手术切缘应≥5.0mm.带蒂胸骨舌骨肌肌瓣是可以信赖的修复方法.     

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.     

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

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.     

早期声门区癌的手术治疗及疗效评估

目的 探讨T1、T2早期声门型喉癌的治疗方法。方法 对112 例T1、T2早期声门型喉癌(其中T1N0M0 80例、T2N0M0 32例)患者施行喉小部分切除术。结果 112 例患者切口均Ⅰ期愈合,6～7d拆线,术后2～3d恢复经口进食,术后第5～6d更换小号气管套管,1～2d后试堵管,平均戴管时间7.3d,拔管率100%;纤维喉镜检查见术后6个月声门裂形态接近正常且闭合严密。嗓音学分析结果示术前、术后1周与术后2个月、6个月Shimmer和NNE对比,差异有统计学意义(P<0. 01);随访满3年76例,全部生存;满5年36例,35例生存(1例不明原因死亡),生存率97.2%。结论 早期声门区喉癌施行喉部分切除术,疗效确切,可获得稳定的局部控制率。在彻底切除肿瘤的前提下,最大限度地减少了手术造成的创伤,住院时间缩短,患者及家属的经济负担减轻,最大程度地保留和重建了患者的喉功能。     

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.     

喉前淋巴结转移对声门型喉癌治疗的指导作用

目的探讨声门型喉癌喉前淋巴结转移的规律,为改进喉癌规范手术提供依据。方法回顾性分析2006年1月~2015年12月手术方式治疗的73例声门型喉癌患者的病例资料,比较早期喉癌和中晚期喉癌之间、喉前淋巴结阳性组和阴性组之间的肿瘤分期、病理分型、术后颈部淋巴结转移、术后局部复发和生存时间的差异。结果73例声门型喉癌患者中喉前淋巴结阳性率4例,阳性率5.47%（4/73）。中晚期喉癌（Ⅲ期、Ⅳ期）比早期喉癌（Ⅰ、Ⅱ期）更容易发生颈部淋巴结转移和喉前淋巴结转移,差异均具有统计学意义（P<0.05）。喉前淋巴结转移、颈部淋巴结转移均与病理分型差异无统计学意义（P>0.05）。中晚期喉癌较早期喉癌更容易发生术后淋巴结转移;喉前淋巴结阳性比阴性更容易发生术后淋巴结转移;差异均具有统计学意义（P<0.05）。中晚期喉癌较早期喉癌更容易发生术后局部复发;喉前淋巴结阳性比阴性更容易发生术后局部复发;差异均具有统计学意义（P<0.05）。喉前淋巴结阳性比阴性组生存时间短,差异具有统计学意义（P<0.05）。结论喉前淋巴结转移在中晚期喉癌中发生率较高,应常规予以清扫。发生喉前淋巴转移的患者术后颈部淋巴结转移和术后局部复发几率均增加,预后较差,提示需要术后进一步治疗的必要性。     

激光治疗喉声门型癌手术切缘安全性研究

目的 分析喉声门型癌激光治疗的安全性。方法 喉声门型鳞状细胞癌50例(1996年8月-1998年10月),支撑喉镜下CO2激光切除肿瘤。喉癌标本常规石蜡包埋和连续切片,单数HE染色,双数行PCNA特异染色。切缘残留肿瘤用同样方法检查。结果 切缘安全26例,相对安全19例,阳性5例。T1a、T1b和T2的阳性率分别为3.6％(1/28),14.3％(2/14)和25.0％(2/8)(P<0.01)。免疫组化染色与常规HE染色切片观察切缘结果相同。激光手术切缘的组织病理学观察可见激光切缘有烧灼后的组织变性,激光切缘有4-8层细胞坏死。部分切除组织中可见软骨组织。50例患者观察5年以上,局部复发S例,其中切缘阳性4例,切缘相对安全1例。结论 激光手术切除的喉癌标本连续切片观察结果显示支撑喉镜下CO2激光手术切除早期喉声门型癌可获得安全切缘。     

Cricohyoidoepiglottopexy vs near-total laryngectomy with epiglottic reconstruction in the treatment of early glottic carcinoma

OBJECTIVE: To compare functional and oncological outcomes of cricohyoidoepiglottopexy (CHEP) and near-total laryngectomy with epiglottic reconstruction (NTLER) techniques in early glottic carcinoma. DESIGN: Case series, clinical study. SETTING: Two tertiary care referral centers. PATIENTS: Seventeen patients with T1b glottic squamous cell carcinoma were treated with CHEP and 21 were treated with NTLER. MAIN OUTCOME MEASURES: Fundamental frequency, maximum phonation time, maximum phonation intensity, Voice Handicap Index, and GRBAS (grade, roughness, breathiness, asthenia, and strain) scale were used to evaluate voice. Nasogastric tube removal times and late postoperative aspiration scales were used to evaluate swallowing ability. RESULTS: Fundamental frequency (P=.78), maximum phonation time (P=.44), and maximum phonation intensity (P=.94) measurements were not significantly different in the 2 groups. There was also no significant difference in mean Voice Handicap Index score (P=.62), mean decannulation time (P=.25), time to nasogastric tube removal (P=.12), or clinical grades of late postoperative aspiration (P=.87) between the 2 groups. The mean Voice Handicap Index score was 55.58 in the CHEP group and 52.78 in the NTLER group. According to the GBRAS scale, overall voice quality was moderately altered in both groups. All patients were successfully decannulated. In the CHEP and NTLER groups, the mean decannulation times were 27 and 20 days, respectively, and the nasogastric tubes were removed after an average of 23 and 17 days. The overall (Kaplan-Meier) survival rate was 94% in the patients who underwent CHEP and 90% in the patients who underwent NTLER (P=.76). The disease-free survival rates were 100% and 76% in the CHEP and NTLER groups, respectively (P=.07). CONCLUSIONS: Functional and oncological results appear to be similar with both treatment methods. If open surgery is planned, the choice between these procedures mainly depends on the experience and preference of the surgeon.     

Functional outcomes after CO2 laser treatment of early glottic carcinoma

OBJECTIVES: To analyze vocal outcome after endoscopic CO2 laser treatment of early glottic carcinoma by perceptive and objective assessment. STUDY DESIGN: Retrospective study. METHODS: Retrospective analysis of 141 consecutive patients undergoing surgery for previously untreated early glottic carcinoma between October 1993 and July 2003. Five types of laser cordectomies as classified by the European Laryngological Society classification were performed. Comparison of voice results between the different types of cordectomies as well as with a control group was performed. RESULTS: There was no significant difference in the vocal parameters between subepithelial and subligamental cordectomies and controls (P > .05). There was, however, a significant difference between the groups of transmuscular, total, and extended cordectomies and controls (P < .05). CONCLUSIONS: Good oncologic results and vocal outcomes with no difference between controls and subepithelial and subligamental cordectomies support the use of CO2 laser endoscopic surgery as the first line of treatment for early glottic cancer.     

The treatment of T3 glottic carcinoma with vertical partial laryngectomy

Total laryngectomy has traditionally been considered the optimal treatment for patients with advanced glottic carcinoma who present with a fixed true vocal cord. However, using whole-organ sectioning techniques, it has been demonstrated that vertical partial laryngectomy is a sound oncologic procedure for selected fixed vocal cord lesions. During the period 1969 to 1984, 27 patients who presented at UCLA with T3 glottic carcinoma were treated using vertical partial laryngectomy. Follow-up for these patients averaged 4.0 years. The absolute two-year disease-free survival rate for this group was 85% (23 of 27 patients), and the local cancer recurrence rate during a two-year postoperative interval was 11% (three of 27 patients). These encouraging results support the continued use of partial laryngeal surgery for a subgroup of patients with T3 glottic cancer. Successful patient selection requires a careful analysis of disease extent based on data obtained from physical examination, magnetic resonance imaging or computed tomographic scanning, and direct laryngoscopy.     

Radiosurgery in the treatment of laryngeal abductor paralysis

Abductor true vocal cord paralysis is a complex condition that requires the surgeon to perform an emergency tracheotomy to eliminate the symptom of dyspnea. Throughout the past 20 years, corrective surgery has reverted to techniques using external or endoscopic techniques. For 5 years now, we have used high frequency radiosurgery by Ellman to treat various ENT conditions in our clinic. The experience we have gained has encouraged us to use this method in endoscopic surgery as well, in the treatment of laryngeal abductor paralysis under suspension microlaryngoscopy. Twelve patients were examined between 1999 and 2002. Diagnosis was performed through flexible fiberoptic videolaryngoscopy. After describing the surgical procedure performed, we underline the advantages of radiosurgery in the treatment of abductor paralysis of the larynx.     

The treatment of glottic carcinoma: an analysis of 800 cases.

All patients with cancer of the glottis seen at the Ontario Cancer Institute from 1955 to 1971 are reviewed. Changes in referral patterns and treatment policy are noted. Particular attention is given to those patients who received radiation for cure, and the place of laryngectomy in their subsequent management is examined. Of the estimated incidence of the disease in the geographic region served, 95 percent are now being seen and of these 97 percent receive treatment with curative intent. Two-thirds or 67 percent are cured at five years and their larynges intact, while a further 18 percent are cured by subsequent laryngectomy.     

Early glottic carcinoma involving the anterior commissure

Between 1958 and 1990 67 patients with an early glottic carcinoma involving the anterior commissure were treated by radiotherapy. Excluding three with carcinoma in situ, 64 had a T₁N₀M₀ squamous cell carcinoma; in eight of these (12.5%) the tumour was only located in the anterior commissure, in 45 (70.3%) it also involved one vocal cord and in 11 (17.2%) both vocal cords. The overall 5-year survival rate was 85%. For those with only anterior commissure involvement it was 60%, with involvement of one vocal cord and the anterior commissure it was 89% and with involvement of both vocal cords 82%. The 3-year recurrence rate was 58% for patients with involvement of only the anterior commissure, 24% with involvement also of one vocal cord, and 45% for those with involvement of both vocal cords. It was found that in cases of early glottic carcinoma, involving the anterior commissure and treated by radiotherapy, the prognosis for recurrence and survival was poorest when the carcinoma was only located in the anterior commissure, and it was concluded that this group of patients deserves special consideration.