CAJ | 학술논문

目的分析CO2激光治疗声门型喉癌的适应证、手术要点和并发症的预防.方法回顾性分析复旦大学附属眼耳鼻喉科医院2003年3月至2006年6月间应用CO2激光治疗的60例无转移的声门型喉癌(T1期52例和,12期8例)的疗效和手术并发症.结果所有病例术后声音嘶哑都比较明显,随着患侧声带切除后的逐渐修复,发音逐渐响亮,1年左右接近正常发音或轻度嘶哑.术后无气管切开、误吸和呼吸困难患者,除2例双侧声带癌行双侧声带切除后发生前连合粘连外,无其他严重并发症.60例喉癌病例中,54例术后随访2～5年无瘤生存.术后复发4例,1例再次激光手术,随访至今2年无瘤生存;3例改为喉全切除术,其中1例随访2年无瘤生存,2例再次复发死亡.术后4年和5年各失访1例.以Kaplan-Maier法统计累积生存率,3年和5年生存率分别为100.0%和91.5%.结论激光作为一种微创技术,在喉癌的外科治疗中具有广泛的应用前景.激光手术创伤小,出血少,恢复快,疗效好,且能保留较为满意的发音功能,是治疗T1、T2声门型喉癌的理想方法,值得推广.
목적 분석CO2격광치료성문형후암적괄응증、수술요점화병발증적예방.방법 회고성분석복단대학부속안이비후과의원2003년3월지2006년6월간응용CO2격광치료적60례무전이적성문형후암(T1기52례화,12기8례)적료효화수술병발증.결과 소유병례술후성음시아도비교명현,수착환측성대절제후적축점수복,발음축점향량,1년좌우접근정상발음혹경도시아.술후무기관절개、오흡화호흡곤난환자,제2례쌍측성대암행쌍측성대절제후발생전련합점련외,무기타엄중병발증.60례후암병례중,54례술후수방2～5년무류생존.술후복발4례,1례재차격광수술,수방지금2년무류생존;3례개위후전절제술,기중1례수방2년무류생존,2례재차복발사망.술후4년화5년각실방1례.이Kaplan-Maier법통계루적생존솔,3년화5년생존솔분별위100.0%화91.5%.결론 격광작위일충미창기술,재후암적외과치료중구유엄범적응용전경.격광수술창상소,출혈소,회복쾌,료효호,차능보류교위만의적발음공능,시치료T1、T2성문형후암적이상방법,치득추엄.
Objective To discuss the indications, surgical technique and complications of CO2 laser in the treatment of glottic cancer. Methods Sixty cases of glottic cancer (T1 = 52, T2 = 8) operated with CO2 laser between 2003 and 2006 were retrospectively analyzed. Results All patients had remarkable hoarseness after the surgery. Their voice improved progressively in the process of the postoperative healing. Most of our patients had a near normal voice or only had a mild hoarseness in a year. None of our patients had tracheotomy during and after the operation. No aspiration occurred as well Except adhesion of anterior commission occurred in two cases of T1b tumors who underwent bilateral vocal cords resection, no other complications occurred in this series. Among 60 cases of glottic carcinoma, 54 cases were followed up postoperatively from 2 to 5 years without recurrence. Four cases had local recurrences. One patient had salvage surgery with CO2 laser and was followed up for 2 years without recurrence. Other three cases had salvage total laryngectomy. One patient followed up for 2 years without recurrence, while another two cases died of recurrence. Two cases were lost during the follow up. Three-year and five-year overall survival rate were 100. 0% and 91.5%, respectively. Conclusions CO2 laser surgery is a minimally invasive, effective and safe procedure for T1 and T2 glottic cancer. Satisfactory exposure, good surgical skill and appropriate surgical indication are fundamental for the success of treatment.