CAJ | 학술논문

目的比较经口腔CO2激光与传统手术治疗早期会厌癌的临床疗效,探讨CO2激光完整切除会厌的手术方式.方法对2006年6月至2009年11月期间在哈尔滨医科大学附属第二医院耳鼻咽喉头颈外科治疗的49例T1-2NOMO会厌癌患者进行回顾性分析.17例接受经口腔CO2激光切除手术,甲状软骨上缘和“会厌结节下凹陷”可作为CO2激光切除会厌癌的术中标志；32例行传统喉声门上水平部分切除手术.34例患者同期行功能性颈淋巴清扫术(Ⅱ、Ⅲ区),13例边缘型及2例较局限的喉面型肿瘤行颈部观察随诊.结果 49例患者随访时间最长6年,最短3年,无失访病例.17例激光手术治疗患者中2例局部复发,给予再次激光手术后未复发,且无死亡病例.32例行传统手术患者2例局部复发,1例给予放疗(60 Gy),1例行喉全切除术,死亡3例.本组淋巴转移率为10.2％ (5/49).激光手术患者鼻饲及住院时间中位数分别为7d和6d,明显少于传统手术.Kaplan-Meier法计算激光手术和传统手术患者的3年存活率分别为100％和90.6％.结论术中确认解剖标识是激光切除会厌癌的技术保证；手术不损伤喉部解剖结构,且无需气管切开,保证了患者喉部功能的顺利恢复；对于局限在会厌的早期病变,经口腔CO2激光手术可作为首选治疗方案.
목적 비교경구강CO2격광여전통수술치료조기회염암적림상료효,탐토CO2격광완정절제회염적수술방식.방법 대2006년6월지2009년11월기간재합이빈의과대학부속제이의원이비인후두경외과치료적49례T1-2NOMO회염암환자진행회고성분석.17례접수경구강CO2격광절제수술,갑상연골상연화“회염결절하요함”가작위CO2격광절제회염암적술중표지；32례행전통후성문상수평부분절제수술.34례환자동기행공능성경림파청소술(Ⅱ、Ⅲ구),13례변연형급2례교국한적후면형종류행경부관찰수진.결과 49례환자수방시간최장6년,최단3년,무실방병례.17례격광수술치료환자중2례국부복발,급여재차격광수술후미복발,차무사망병례.32례행전통수술환자2례국부복발,1례급여방료(60 Gy),1례행후전절제술,사망3례.본조림파전이솔위10.2％ (5/49).격광수술환자비사급주원시간중위수분별위7d화6d,명현소우전통수술.Kaplan-Meier법계산격광수술화전통수술환자적3년존활솔분별위100％화90.6％.결론 술중학인해부표식시격광절제회염암적기술보증；수술불손상후부해부결구,차무수기관절개,보증료환자후부공능적순리회복；대우국한재회염적조기병변,경구강CO2격광수술가작위수선치료방안.
Objective To compare the functional results of transoral CO2 laser epiglottectomy with transcervical supraglottic laryngectomy and to find the landmarks for CO2 laser surgery.Methods Fortynine preoperatively untreated patients diagnosed as clinical T1-2N0M0 epiglottic carcinomas enrolled from June 1,2006,to November 1,2009 in the Second Affiliated Hospital of Harbin Medical University were studied retrospectively.Seventeen cases were treated by CO2 laser whereas 32 by open surgeries.The upper edge of thyroid cartilage and mucosal recess infra epiglottic tubercle could be used as intraoperation landmarks for transoral CO2 laser surgery.Optional neck dissections (Ⅱ,Ⅲ) were performed for 34 patients with tumors on laryngeal face,but not for 15 with tumors on the edges of epiglottis or small laryngeal face tumors.Results The follow-up for this study covers a period ranging from 3 to 6 years postoperatively.Four local recurrences were found for this study,2 for laser surgery who underwent additional repeated exisions and 2 for conventional techniques,one received radiotherapy (60 Gy) and another with total laryngectomy.The incidence of lymph node metastasis was 10.2％ (5/49) in all cases.Time of naso-feeding or hospitalisation was significantly shorter for CO2 laser treated patients than that for open techniques.Overall 3 year's survival rates were 100％ and 90.6％ for CO2 laser and the open techniques respectively.Conclusions Compared to the open technique,transoral CO2 laser epiglottectomy is a well-tolerated and promising resection technique with low morbidity for early epiglottic carcinomas,and the identification of landmarks is useful for entire resection of epiglottis.