CO2激光内镜下切除早期不同类型喉癌的临床效果和并发症分析

目的 探讨光纤CO₂激光技术治疗早期喉癌的效果、经验和并发症分析。方法 选取山东第一医科大学附属聊城市第二人民医院2014年11月至2019年11月间收治的老年早期喉癌（T₁~T₂）患者88例进行回顾性研究。所有患者采取光纤CO₂激光内镜手术治疗,分析患者的临床效果、术后功能恢复情况和并发症发生,以及并发症与复发率的关系。结果 术中没有发生误伤、大量出血等并发症。2年术后随访,复发11例（12.50%）,复发时间16.8±8.9个月。局部复发10例（11.36%）：5例采用再次TLM（1例Ⅱ型、1例Ⅲ型、3例V型）,2例采用RT治疗,1例环状软骨上型采用开放性手术,2例实施全喉切除术后辅助放疗。病理分期、前连合侵犯、肿瘤侵犯深度与复发之间相关（分别为P=0.035、P=0.017、P=0.025）。其他参数均无统计学意义。结论 CO₂激光技术治疗老年早期喉癌具有喉功能恢复良好、住院时间短、并发症少的特点;病理分期、前连合侵犯、肿瘤侵犯深度与复发有关联。

Clinical and complication assessment of CO2 laser-assisted endoscopic surgery for T1-T2 laryngeal cancers

Objective To study the effect, experience and complications of CO₂ laser-assisted endoscopic surgery in the treatment of early laryngeal cancer. Methods Eighty-eight patients with early laryngeal cancer （T1-T2） admitted to Liaocheng Second People's Hospital （the Affiliated to Shandong First Medical University） from November 2014 to November 2019 were retrospectively studied. All patients underwent CO₂ laser-assisted endoscopic surgery. The clinical effect, postoperative functional recovery and complications, as well as the relationship between complications and recurrence rate were analyzed. Results There were no complications such as accidental injury and massive bleeding. During two years of follow-up, 11 cases （12.50%） relapsed, and the recurrence time was 16.8±8.9 months. Local recurrence occurred in 10 cases （11.36%）： 5 cases were treated with TLM again （1 case of type Ⅱ, 1 case of type Ⅲ and 3 cases of type V）, 2 cases were treated with RT, 1 case of supracricoid type was treated with open surgery, and 2 cases were treated with adjuvant radiotherapy after total laryngectomy. Pathological stage, anterior commissural invasion and depth of tumor invasion were correlated with local recurrence （P=0.035, P=0.017, P=0.025, respectively）. Other parameters were not statistically significant. Conclusion CO₂ laser-assisted endoscopic surgery for laryngeal cancer has the characteristics of good recovery of laryngeal function, short hospitalization time and low complications; pathological stage, anterior commissural invasion and depth of tumor invasion are associated with recurrence.