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。

Security of surgical excision of CO2 laser in the treatment for glottic carcinoma

OBJECTIVE To exptore the security of sur- gical excision of CO2 laser in the surgical treatment for glottic carcinoma. METHODS Fifty specimens were taken from glottic squamous cell carcinoma patients during CO2 laser surgery under self-retaining laryngoscope. After routine paraffin embedding and paraffin serial sectioning, odd-number cases were stained with HE, even cases were under specific staining against proliferating nuclear antigen (PCNA )with SP immunohistochemistry staining method. The incisal edge were also detected for residual tumor. RESULTS The edge of laser surgical incision, among the 50 specimens, 26 were safe, 19 relatively safe and 5 positive. The positive rate of T1a, T1b and T2 were 3.6 % (1 /28), 14. 3 % (2/14) and 25.0 % (2/8) respectively, with significant differences (P< 0.01). Same results were achieved with immunohistochemistry staining and routine HE staining. His-topathological observation of the incisal edge showed tissue deposition and necrosis of 4-8 layers of cells after laser burning. Cartilage tissue were also seen in the removal tissues. All patients were followed for 5 years, and 5 of them (10 %) had a local recurrence. 4 cases of 5 had a positive cutting edge and one case had a relatively safe edge. CONCLUSION Serial sectioning study of specimens after laser laryngectomy indicate that CO2 laser surgery is safe and useful in obtaining a safe edge during surgical excision of early stage glottic laryngeal carcinoma