CO2激光联合低温等离子治疗早期声门型喉癌40例

目的 探讨CO₂激光联合低温等离子治疗早期声门型喉癌(EGC)的临床疗效。 方法 回顾性分析内镜下CO₂激光联合低温等离子治疗的40例EGC患者的临床资料,观察术后治疗效果及复发情况。 结果 所有患者首次手术均为内镜下CO₂激光联合低温等离子切除术,共随访4.2~32.0个月(平均18.6个月)。40例均未失访,复发1次3例,复发2次2例,复发率12.5%。复发后行喉全切除术2例,复发后行喉垂直部分切除术1例,复发后行颈淋巴结清扫术1例,复发后再行CO₂激光联合低温等离子切除术+气管切开术1例。 其中喉全切除再次复发行放、化疗及介入治疗,治疗效果差1例;喉垂直部分切除再次复发后选择放疗1例,治疗情况欠佳;余3例末次手术后恢复良好。术后肉芽组织增生9例,术后出现声带粘连4例。36例患者术后发音功能恢复满意,恢复欠佳2例,复发行喉全切除术后丧失发音功能2例。 结论 内镜下CO₂激光联合低温等离子治疗EGC可弥补激光和低温等离子单一治疗模式的不足、提高手术效率,临床有效可行。

Forty cases of early glottic cancer treated by CO2 laser surgery combined with radiofrequency ablation

Objective To explore the clinical efficacy of endoscopic CO₂ laser surgery combined with low-temperature plasma radiofrequency ablation(LTP-RFA). Methods We retrospectively analyzed the clinical data of 40 patients with early glottic cancer treated by endoscopic CO₂ laser surgery combined with LTP-RFA. Results All patients initially underwent endoscopic CO₂ laser surgery combined with LTP-RFA. The patients were followed up for 4.2-32.0(18.6)months; none were lost to follow-up. Three cases experienced recurrence once and two cases, twice. The recurrence rate was 12.5%. Total laryngectomy was performed in two cases, vertical partial laryngectomy in one case, selective neck dissection in one case, and combined surgery with tracheotomy in one case. One patient who experienced recurrence after total laryngectomy received chemoradiotherapy and interventional therapy, but the therapeutic effect was poor. One patient with recurrence after vertical partial laryngectomy, with an otherwise good general condition, opted for radiotherapy. The other three patients recovered well after their last surgery. Granulation tissue was observed in nine cases postoperatively and healed completely after 1-6 months. Mild vocal cord adhesion was observed in four patients. Postoperative vocal function was good in 36 patients, poor in 2 patients, and lost in 2 patients after total laryngectomy. Conclusion Endoscopic CO₂ laser surgery combined with LTP-RFA for the treatment of early glottic cancer helps overcome the limitations of the two methods when used alone and helps improve surgical efficiency. It is an effective and feasible surgery.