Feasibility and efficacy of a thyroid cartilage window technique for transoral CO2 laser resection of early glottic cancer involving the anterior commissure
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摘要: 目的 探讨应用经口CO2激光甲状软骨窗式切除(TCWR)技术治疗累及前连合的早期声门型喉癌的可行性及疗效。方法 回顾性分析2015年6月1日—2018年9月30日在南京同仁耳鼻喉医院接受经口CO2激光TCWR技术治疗的21例累及前连合的早期声门型喉癌患者资料，总结分析术中切缘情况、并发症、嗓音恢复、局部控制率及无复发生存率。结果 21例均行经口CO2激光声门区肿物切除+TCWR技术，阴性切缘达到100%。平均随访41.1个月，局部控制率达到100%。2例(9.5%)有声门下受累的T2病变患者，随访中发现喉前淋巴结区域性复发；5年无复发生存率为90.5%。21例患者术后均发现声门区域肉芽形成，其中13例(61.9%)自然消失；8例(38.1%)持续存在超过12周，予以黏膜表面麻醉下手术摘除。21例患者均有不同程度的喉蹼形成，但未出现呼吸困难和喉狭窄。嗓音障碍指数手术前后比较差异有统计学意义(P=0.01)，GRBAS评估的G分级和客观评估参数包括最长发声时间、基频微扰、振幅微扰手术前后比较，差异无统计学意义(均P>0.05)。结论 经口CO2激光TCWR技术治疗累及前连合的早期声门型喉癌并发症少，嗓音质量恢复良好，可有效提高前切缘的安全性，是一种有效的治疗方法。Abstract: Objective To evaluate the feasibility and efficacy of a thyroid cartilage window resection(TCWR) technique for transoral CO2laser resection of early glottic cancer with involvement of the anterior commissure.Methods Twenty-one patient who underwent a TCWR technique for transoral CO2laser resection early glottic carcinoma involving the anterior commissure, were retrospectively analyzed. Indices including margin status, perioperative comorbidities, voice outcomes, local control rate and recurrence free survival, were assessed.Results All 21 patients underwent a TCWR technique for resection, the organ preservation rate and negative margin achieved 100%. The local control rate achieved 100%. For two patients with subglottic involvement(9.5%), regional recurrence with confirmation of a positive pre-laryngeal lymph node was subsequently observed; and the 5 years recurrence free survival was 90.5%. Postoperative granulomas were detected in all 21 patients in 4 weeks postoperatively, 13 of which(61.9%) spontaneously disappeared; whereas the remaining 8 patients(38.1%) demonstrated consistent presence of granuloma more than 12 weeks and underwent an additional surgical extirpation under topical anesthesia. Despite the laryngeal web developed in all 21 patients, no dyspnea and laryngeal stenosis occurred at the time of analysis. By comparison with preoperative baseline, postoperative self-assessment voice demonstrated a significant improvement(P=0.01), while objective voice indices were not significantly altered(P>0.05).Conclusion TCWR technique is a valuable means for transoral CO2laser resection of early glottic laryngeal cancer involving the anterior commissure, with favorable voice quality and seemingly low comorbidities, which can effectively improve the safety of the anterior resection margin.
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Key words:
- anterior commissure /
- laryngeal neoplasms /
- CO2laser /
- microsurgery /
- thyroid cartilage window resection
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表 1 手术前后嗓音质量评估
术前 术后 P G分级 1.95±0.18 1.87±0.21 0.19 VHI 46.62±6.67 40.95±6.01 0.01 最长发声时间 9.19±3.22 8.29±1.95 0.38 基频微扰 2.62±0.46 2.71±0.56 0.94 振幅微扰 5.21±1.03 4.84±0.19 0.09 
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