支撑喉镜下CO2激光喉部分切除最大范围的实验研究

目的 通过实验动物激光手术,探索激光手术治疗声门型和声门型喉癌的安全性和手术切除范围。方法 选实验狗10只,模拟支撑喉镜下CO2激光手术,按标准的喉垂直部分或声门上水平部分切除术的切除范围,完成喉垂直部分切除7只,声门上水平部分切除3只。分别于术后立即(5只)和术后饲养40 d(5只)后麻醉状态下空气栓塞法处死。切除实验狗全喉,连续切片观察切除范围和手术后创面修复情况。结果 10只实验狗手术完成顺利,显微镜下观察满意,达到手术预期的切除范围,大体标本和连续切片观察1-5号狗喉标本,切除范围与手术一致,创面有激光烧灼后的黑色和黄褐色结痂。6-10号狗饲养40 d时处死,创面已修复。结论 动物支撑喉镜下CO2激光手术可完成经典的喉垂直部分切除术和声门上水平部分切除术的软组织切除范围,动物可存活,创面自行修复,提示扩大喉癌激光手术切除范围的可能性。

Largest extension of CO2 laser surgery for laryngeal cancer in experimental animals

Objective To explore the security and limit resection extension of CO2 laser surgery for laryngeal cancer in experimental animal under self-retaining laryngoscope. Methods Ten experimental dogs were selected and received CO2 laser surgery with self-retaining laryngoscope. Vertical partial or supraglottic horizontal laryngectomy was performed according to the surgical criteria. All the dogs were killed immediately (5/10) or 40 days later(5/10) by using air embolus postopertively . The whole larynx was taken out, and specimens were embedded with colloidion and then serially sectioned. Dimension of excision and wound surface recovery status were observed. Results All the operations on experiment animals were successful and the results were satisfactory. The excision dimension was the same as standard surgery. Gross specimens and serial sectioning staining of 5 dogs were performed. And the other 5 dogs wound surface had already recovered. Conclusions CO2 laser surgery was comparable with traditional vertical partial laryngectomy and supraglottic horizontal laryngectomy for excision size. Animals were able to survive the surgery, wound surface could recover spontaneously . It suggested the possiblity of extended laryngectomy with laser.