CAJ | 학술논문

目的：支撑喉镜下手术切除是治疗成人喉乳头状瘤的主要方法，文中分析支撑喉镜下二氧化碳激光治疗成人喉乳头状瘤的近期和远期疗效，并与传统的肿瘤钳除术进行对比。方法收集2012年1月至2014年6月在南京军区南京总医院接受治疗并符合纳入和排除标准的成人喉乳头状瘤患者61例临床资料，依据治疗方法分为观察组26例（二氧化碳激光切除）和对照组35例（肿瘤钳除术）。比较2组患者一般临床资料，短期临床效果（手术时间、住院时间、手术并发症、短期疗效）、手术前后免疫炎症指标的变化以及长期疗效（术后1年的复发率）。结果观察组患者手术时间、住院时间均显著低于对照组[（33．66±4．71）min vs （37．19±5．21）min、（4．07±1．25）d vs （4．83±1．38）d， P＜0．05]；2组手术并发症和短期疗效差异均无统计学意义（P＞0．05）。术后3 d免疫炎症指标C-反应蛋白、白细胞介素-6、肿瘤坏死因子-α及白细胞介素-1β水平，观察组分别为（6．15±1．67）mg／L、（6．51±1．12）ng／L、（23．56±4．16）ng／L、（5．25±1．21）ng／L，对照组分别为（12．20±3．41）mg／L、（15．63±4．11）ng／L、（36．16±7．37）ng／L、（12．63±4．12）ng／L，组间比较差异均有统计学意义（P＜0．001）。观察组患者术后1年累积复发率显著低于对照组（12．00％ vs 37．93％， P＝0．029）。结论在成人喉乳头状瘤的手术治疗中，与传统的肿瘤钳除术相比，二氧化碳激光手术的创伤更小，术后恢复更快，复发率更低，值得临床推广。
목적：지탱후경하수술절제시치료성인후유두상류적주요방법，문중분석지탱후경하이양화탄격광치료성인후유두상류적근기화원기료효，병여전통적종류겸제술진행대비。방법수집2012년1월지2014년6월재남경군구남경총의원접수치료병부합납입화배제표준적성인후유두상류환자61례림상자료，의거치료방법분위관찰조26례（이양화탄격광절제）화대조조35례（종류겸제술）。비교2조환자일반림상자료，단기림상효과（수술시간、주원시간、수술병발증、단기료효）、수술전후면역염증지표적변화이급장기료효（술후1년적복발솔）。결과관찰조환자수술시간、주원시간균현저저우대조조[（33．66±4．71）min vs （37．19±5．21）min、（4．07±1．25）d vs （4．83±1．38）d， P＜0．05]；2조수술병발증화단기료효차이균무통계학의의（P＞0．05）。술후3 d면역염증지표C-반응단백、백세포개소-6、종류배사인자-α급백세포개소-1β수평，관찰조분별위（6．15±1．67）mg／L、（6．51±1．12）ng／L、（23．56±4．16）ng／L、（5．25±1．21）ng／L，대조조분별위（12．20±3．41）mg／L、（15．63±4．11）ng／L、（36．16±7．37）ng／L、（12．63±4．12）ng／L，조간비교차이균유통계학의의（P＜0．001）。관찰조환자술후1년루적복발솔현저저우대조조（12．00％ vs 37．93％， P＝0．029）。결론재성인후유두상류적수술치료중，여전통적종류겸제술상비，이양화탄격광수술적창상경소，술후회복경쾌，복발솔경저，치득림상추엄。
Objective Our study was aimed to study the clinical effect of carbon dioxide laser in the treatment of adult laryn -geal papilloma . Methods Clinical data of patients with adult laryngeal papilloma received treatment at our hospital from January 2012 to June 2014 was retrospectively analyzed .Patients were divided into two groups according to the type of treatment , observation group:received carbon dioxide laser treatment;control group:received tumor forceps treatment .Participants included 61 cases of pa-tients, the observation group of 26 cases, control group 35 cases.Compare the general clinical data , short-term clinical effects(opera-tion time, length of hospital stay , complications , short-term curative effect ) , the change of immune inflammation indexes before and after operation and postoperative recurrence in 1 year of two groups patients. Results The operation time and the length of hospital stay in observation group was significantly lower than that in control group[(33.66 ±4.71)min vs (37.19 ±5.21)min,(4.07 ±1.25)d vs (4.83 ±1.38)d, P<0.05].On the 3th day, The levels of CRP、IL-6、TNF-αand IL-1βin observation group were ( 6.15 ±1.67 ) mg/L, (6.51 ±1.12)ng/L, (23.56 ±4.16)ng/L, (5.25 ±1.21) ng/L, those in control group were (12.20 ±3.41)mg/L, (15.63 ± <br> 4.11) ng/L, (36.16 ±7.37) ng/L, (12.63 ±4.12) ng/L.The differences of these parameters between the two groups were signifi-cant (P<0.001).Observation group patients had a lower rate of recurrence 1 year after surgery than that of control group patients (12.00%vs 37.93%, P=0.029). Conclusion In the treatment of adult laryngeal papilloma , carbon dioxide laser can achieve a better minimally invasive and lower postoperative recurrence when compare to tumor forceps treatment .