CO2激光手术治疗声门上型喉癌

目的 总结CO2激光手术治疗声门上型喉癌的临床治疗效果.方法 回顾性分析1995年2月至2005年6月CO2激光手术治疗的32例声门上型喉癌患者临床资料.32例患者中T1N0M0 20例,T1N1M0 2例,T2N0M0 8例,T2N1M0 2例,全部病例术后随诊3年以上.喉部肿瘤均经口行激光手术,同期行择区性(Ⅱ-Ⅳ区)颈清扫术12例,改良全颈清扫术4例.结果 KaplanMeier法统计5年生存率为90.6%,其中T1病变5年生存率为95.6%,T2病变为78.2%.喉的局部控制率为96.8%;喉局部和颈部区域5年控制率为90.3%,其中T1病变5年局部区域控制率为90.9%,T2病变为89.0%.喉部局部复发2例,1例再治疗行喉水平垂直部分切除术,1例行喉全切除术.颈部区域复发2例,其中1例喉部复发伴颈淋巴转移,再治疗后存活;1例颈部复发,治疗后再次颈部复发并伴肺转移死亡.4例患者出现较轻并发症,保守治疗后好转.除1例患者因局部复发行喉全切除外,其余存活患者喉功能良好.结论 激光治疗早期声门上型喉癌创伤小、疗效可靠,是一种理想的治疗方式.

Treatment of supraglottic carcinoma with carbon dioxide laser

Objective To evaluate the feasibility and curative effects of CO2 laser in treatment of supraglottic carcinoma. Methods The retrospective analysis included 32 case of supraglottic carcinoma from February 1995 to June 2005, TNM classified as follows: T1N0M0:20 cases, T1N1M0:2 cases, T2N0M0:8 cases and T2N1M0:2 cases. The patients were treated with endoscopic laser surgery and selective neck dissection( 12 cases) or functional neck dissection(4 cases). The follow-up period was more than 3 years. Results Kaplan-Meier survival analysis shows the overall 5-year survival rate was 90. 6%, and the 5-year survival rate of T1 lesions and T2 lesions was 95.6% and 78. 2% , respectively. The overall 5-year local control rate was 96. 8%. The 5-year local-regional control rate was 90. 3%. With T1 90. 9% and T2 89. 0% respectively. Two patients had local recurrences, one underwent salvage supraglottic horizontal laryngectomy, another one underwent total laryngectomy. Two cases with regional recurrences underwent radical neck dissection. One of them with concurrent local recurrence was survival after salvage operation. Another one with only regional lesion died of recurrence and pulmonary metastasis after treatment. Four patients experienced minor complications without sequelae. All survival patients had laryngeal preservation except the one who received total laryngectomy. Conclusions The results of this study show that endoscopic CO2 laser surgery is highly effective in the treatment of selected supraglottic carcinoma. It shows reliable curative effects and a high larynx preservation rate.