喉内镜下等离子消融术与开放性手术治疗早期喉癌的疗效对比

目的探讨经支撑喉镜内镜辅助下等离子消融术治疗早期声门型喉癌的疗效,并与常规开放性手术作对比分析。方法回顾早期声门型喉鳞癌55例患者临床资料,按手术方式分为等离子组35例、喉裂开组20例,分析比较两组手术情况、并发症、复发率,并应用嗓音分析软件比较两组患者术后嗓音恢复情况。结果等离子组及喉裂开组患者在手术时间(15.60±7.20)vs(94.00±9.95)min)]、术中出血(8.94±8.06)vs(100.75±28.34)mL]、住院时间(6.86±0.77)vs(11.45±1.05)d]、术后疼痛视觉模拟评分(2.66±0.91)vs(4.65±1.04)分]及呛咳评分(3.60±0.85)vs(6.05±1.23)分]的差异均有统计学意义(P<0.05);两组术后肉芽增生发生率及复发率差异无统计学意义(P>0.05);术后12个月嗓音分析两组嗓音参数(Jitter、Shimmer、HNR)均较术前好转,等离子组上述参数恢复情况均优于喉裂开组:基频微扰(Jitter)(0.66±0.15)vs(0.78±0.18)%],振幅微扰(Shimmer)(4.57±1.14)vs(5.66±0.97)%],谐噪比(HNR)(17.41±2.58)vs(15.39±1.63)dB],组间差异有统计学意义(P<0.05)。结论经支撑喉镜内镜辅助下等离子消融术治疗早期喉癌疗效确切,较喉裂开术具有微创、高效、术后嗓音恢复好的优势。

Curative effect analysis of endoscopic laryngeal surgery with plasma radiofrequency ablation versus open surgery to treat early glottic cancer

Objective To evaluate the clinical efficacy of endoscopic laryngeal surgery with plasma radiofrequency ablation vs. conventional open surgery to treat early glottic cancer. Methods Resection of laryngeal cancer was performed at our hospital between January 2013 and August 2016 in 55 patients with early glottic squamous cell cancer. Endoscopic laryngeal surgery with plasma radiofrequency ablation was performed in 35 patients(plasma group), and open surgery was performed in 20 patients(laryngofissure group). The situation of surgery, complications, recurrence rate, and postoperative change in voice were compared between the groups. Results The intraoperative blood loss(8.94±8.06 vs. 100.75±28.34 mL), operative time(15.60±7.20 vs. 94.00±9.95 min), length of hospitalization(6.86±0.77 vs. 11.45±1.05 days), postoperative pain scores(2.66±0.91 vs. 4.65±1.04), and the cough visual analogue scale scores(3.60±0.85 vs. 6.05±1.23)in the plasma group were better than those in the laryngofissure group(P<0.05). However, no intergroup difference was observed in the granulation hyperplasia and recurrence rates(P>0.05). Acoustic parameters, including fundamental frequency perturbation(jitter)(0.78±0.18 vs. 0.66±0.15%), amplitude perturbation(shimmer)(5.66±0.97 vs. 4.57±1.14%), and the harmonic noise ratio(17.41±2.58 vs. 15.39±1.63 dB)recorded a year postoperatively showed more significant improvement in the plasma than in the laryngofissure group. Notably, this intergroup difference was statistically significant(P<0.05). Conclusion Endoscopic laryngeal surgery with plasma radiofrequency ablation effectively treats early glottic cancer. This procedure scores over open surgery in terms of being a minimally invasive and highly effective approach associated with better voice preservation.