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.

The Analysis of the Recurrence Factors of CO2 Laser Surgery for Tis,T1 and T2 Glottic Cancer

Objective To study the risk factors for recurrence in glottic cancer at Tis,T1 and T2 stage after CO2 laser endoscopic resection.Methods We conducted a retrospective analysis of 180 Tis,T1 and T2 glottic cancer cases treated by CO2 laser surgery.Of the total cases,the Tis stage lesion was found in 22 cases,the T1a in 90,the T1b in 32 and the T2 in 36 cases.Tumor recurrence was set as the time-related endpoint.The recurrence factors were analyzed by univariate and multivariate analysis,including age,gender,T classification,type of cordectomy,tumorgrading,motility of vocal fold and the possible anteior commissure.Results There was a significant statistical difference between the recurrence rate and T classification,and the type of cordectomy(P＜0.05).The recurrence rates of Tis,T1a,T1b and T2 were 9.1％,13.3％,18.8％ and 38.9％,respectively.In type-Ⅰ,Ⅱ,Ⅲ,Ⅳ and Ⅴ of cordectomy,the recurrence rates were 0,3.57％,15.0％,19.60％ and 36.84％.Conclusion The recurrence rate is closely associated with T classification and the type of cordectomy.With the higher T classification and the type of cordectomy,the recurrence rate is dramatically higher.