低温等离子射频消融手术治疗早期喉癌疗效观察

龚霄阳; 陈芝文; 林子萍; 陈海兵; 程雷; 陈曦

doi:10.13201/j.issn.1001-1781.2019.02.012

低温等离子射频消融手术治疗早期喉癌疗效观察

- 南京医科大学第一附属医院江苏省人民医院耳鼻咽喉科(南京, 210029)
基金项目:
江苏高校优势学科建设工程项目 (No:JX10231801)

详细信息

通讯作者: 陈曦,E-mail:gxy.lg@163.com

中图分类号: R739.65

收稿日期: 2018-09-28

Therapeutic effect of low-temperature radiofrequency coblation on early-stage laryngeal cancer

- Department of Otorhinolaryngology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, 210029, China

More Information

Corresponding author: CHEN Xi, E-mail: gxy.lg@163.com

Received Date: 28 September 2018

摘要

摘要: 目的:探讨低温等离子射频消融手术治疗早期喉癌(Tis、T₁和T₂)的安全性、有效性及预后。方法:回顾性分析202例经直达喉镜下低温等离子射频消融手术治疗早期喉癌患者的临床资料,其中Tis期34例(16.83%),T_1aN₀M₀期49例(24.26%),T_1bN₀M₀期50例(24.75%),T₂N₀M₀期69例(34.16%)。对手术患者进行术后严密随访,随访6~60个月,中位随访时间29个月。结果:202例患者中,165例(81.68%)未见复发,均获得了良好的手术效果,均未出现术后出血、呼吸困难等严重并发症;37例(18.32%)术后复发,其中Tis期1例(0.50%),T_1a期7例(3.47%),T_1b期7例(3.47%),T₂期22例(10.89%)。复发患者中13例行全喉切除术(其中5例复发进展为T3期,8例进展为T4期),分别为T_1a期1例、T_1b期2例、T₂期10例;4例行垂直半喉切除手术,分别为T_1a期3例、T₂期1例;5例再次行等离子射频消融手术,分别为T_1b期3例、T₂期2例,后均未再次复发;1例患者喉部未见明显复发但颈部淋巴结转移,遂行单纯颈淋巴结清扫术;1例T₂期患者复发后为解除喉阻塞单纯行气管切开术,后未进一步治疗;3例患者复发后行放化疗好转;死亡9例,其中行放化疗后死亡5例,复发后放弃治疗4例。结论:低温等离子射频消融手术治疗早期喉癌患者在术后保留喉功能、减少手术创伤方面较喉癌传统手术具有较大的优势,并可以获得较为满意的疗效,但在部分T₂期患者的手术适应证选择上仍需慎重。
- 喉肿瘤 /
- 低温等离子 /
- 治疗结局 /
- 生存率
Abstract: Objective:To evaluate the safety, efficacy and prognosis of low-temperature plasma radiofrequency coblation for early-stage laryngeal cancer (Tis, T₁and T₂).Method:A retrospective analysis of 202patients with early-stage laryngeal cancer who underwent the low-temperature radiofrequency coblation surgery, including 34cases of Tis (16.83%), 49cases of stage T_1aN₀M₀ (24.26%), 50cases of stage T_1bN₀M₀ (24.75%) and 69cases of stage T₂N₀M₀ (34.16%).Surgical patients were followed up closely for 6to 60months, with a median follow-up of 29months.Result:Of the 202patients, 165 (81.68%) had no recurrence and achieved good surgical results.None of them suffered severe complications such as post-operative hemorrhage and asphyxia.37cases (18.32%) had recurrence, including 1case (0.50%) in stage Tis, 7cases (3.47%) in stage T_1a, 7cases (3.47%) in stage T_1b, and 22cases (10.89%) in stage T₂.Thirteen patients who had recurrence underwent total laryngectomy (5of which had a recurrence of T₃and 8of which progressed to T₄), including 1in the stage T_1a, 2in the stage T_1b, and 10in the stage T₂.Vertical hemilaryngectomy were performed in 4cases, 3cases of stage T_1aand 1case of stage T₂;5cases underwent plasma radiofrequency coblation again, including 3cases of stage T_1band 2cases of stage T₂, no recurrence was found in all the patients;1patient had no obvious recurrence in the larynx but had cervical lymph node metastasis, radical neck dissection was performed;1patient with stage T₂recurrence was treated with a tracheotomy to relieve laryngeal obstruction without further treatment;3cases showed improvement by radiotherapy and chemotherapy treatment after recurrence;9death cases, 5patients died after radiotherapy and chemotherapy, and 4patients stopped getting treatment after recurrence.Conclusion:Low-temperature radiofrequency coblation surgery for patients with early-stage laryngeal cancer has great advantages in the preservation of laryngeal function and reduction of surgical trauma after surgery compared with traditional surgical method, and can obtain satisfactory results, but the selection of surgical indications for some patients with clinical stage T₂is still need to be carefully considered.
- laryngeal neoplasms /
- coblation /
- treatment outcome /
- survival rate

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