CAJ | 학술논문

目的：分析CO2激光切除术与喉裂开手术对治疗早期喉癌效果的差异，探讨喉癌组织中p27、PTEN蛋白对患者预后的预测价值。方法选取行CO2激光切除术的早期声带癌标本85例( CO2激光治疗组)及行喉裂开手术的早期声带癌标本46例(裂开组)，观察两种术式患者术后复发情况。同时应用免疫组化SP法检测声带癌组织及切缘组织中p27和PTEN蛋白表达，收集临床病理资料并进行随访。结果所有患者均随访2年以上，其中85例CO2激光治疗组14例出现局部复发，复发率16．5%；46例喉裂开术组6例出现复发，复发率为13．0%；两种术式患者的复发率差异无统计学意义( P>0．05)；两组患者中无复发组术后未遵医嘱吸烟者10人，复发组术后未遵医嘱吸烟者12例，两组比较差异有统计学意义( P<0．01)。 p27和PTEN蛋白在声带癌、癌旁切缘组织中阳性率分别为43．5%(57/131)、80．2%(105/131)和48．9%(64/131)、83．2%(109/131)；p27和PTEN蛋白在声带癌组与癌旁切缘对照组的阳性率差异均有显著性(P<0．01)。声带癌复发组和无复发组中p27和PTEN蛋白阳性率分别为20．0%(4/20)、47．7%(53/111)和10．0%(2/20)、55．9%(62/111)。 p27和PTEN蛋白在声带癌复发组与无复发组阳性率差异亦有显著性( P<0．05)。复发组与未复发组切缘组织中p27和PTEN蛋白的阳性率分别为50．0%(10/20)、85．6%(95/111)和40．0%(8/20)、91．0%(101/111)，复发组与未复发组切缘组织中p27和PTEN蛋白的阳性率差异有显著性(P<0．01)。结论 CO2激光手术和传统的喉裂开手术对于肿瘤复发率的差异无统计学意义，肿瘤手术后再次吸烟与肿瘤的复发有密切相关性。 p27及PTEN蛋白阴性的患者复发率高，临床应密切随访。
목적：분석CO2격광절제술여후렬개수술대치료조기후암효과적차이，탐토후암조직중p27、PTEN단백대환자예후적예측개치。방법선취행CO2격광절제술적조기성대암표본85례( CO2격광치료조)급행후렬개수술적조기성대암표본46례(렬개조)，관찰량충술식환자술후복발정황。동시응용면역조화SP법검측성대암조직급절연조직중p27화PTEN단백표체，수집림상병리자료병진행수방。결과소유환자균수방2년이상，기중85례CO2격광치료조14례출현국부복발，복발솔16．5%；46례후렬개술조6례출현복발，복발솔위13．0%；량충술식환자적복발솔차이무통계학의의( P>0．05)；량조환자중무복발조술후미준의촉흡연자10인，복발조술후미준의촉흡연자12례，량조비교차이유통계학의의( P<0．01)。 p27화PTEN단백재성대암、암방절연조직중양성솔분별위43．5%(57/131)、80．2%(105/131)화48．9%(64/131)、83．2%(109/131)；p27화PTEN단백재성대암조여암방절연대조조적양성솔차이균유현저성(P<0．01)。성대암복발조화무복발조중p27화PTEN단백양성솔분별위20．0%(4/20)、47．7%(53/111)화10．0%(2/20)、55．9%(62/111)。 p27화PTEN단백재성대암복발조여무복발조양성솔차이역유현저성( P<0．05)。복발조여미복발조절연조직중p27화PTEN단백적양성솔분별위50．0%(10/20)、85．6%(95/111)화40．0%(8/20)、91．0%(101/111)，복발조여미복발조절연조직중p27화PTEN단백적양성솔차이유현저성(P<0．01)。결론 CO2격광수술화전통적후렬개수술대우종류복발솔적차이무통계학의의，종류수술후재차흡연여종류적복발유밀절상관성。 p27급PTEN단백음성적환자복발솔고，림상응밀절수방。
Purpose To compare the therapeutic effects of CO2 laser resection and traditional split laryngeal surgery on the early laryn-geal cancer, and to examine relationship between the expression of p27 and PTEN and clinical prognosis in early laryngeal squamous cell carcinoma. Methods 85 patients who underwent CO2 laser resection surgery and 46 patients who underwent split laryngeal surger-y were selected and the occurrence rates after surgery were observed. SP immunohistochemical method was uesd to detect the expression of p27 and PTEN in tumor resection marginal and their surgical margine tissues. Clinical data were collected and all patients were fol-lowed up. Results In the more than two-year follow-up study, 14 of 85 patients in CO2 laser treatment group ( recurrent group) pres-ented with local recurrence and the recurrence rate was 16. 5%, while 6 of 46 patients in split laryngeal surgery group presented with local recurrence and the recurrent rate was 13. 0%. There was no statistical significance in recurrence rate between the two groups ( P> 0. 05). 10 of all the none recurrent patients did not follow the doctor’s advice to quit smoking after the operation, while 12 in the recurrent patients did not, the difference between the two groups was statistically significant (P<0. 01). The positive rate of p27 and PTEN in laryngeal carcinoma tissues and the cancer adjacent tissues ( negative surgical margin tissues ) was 43. 5% ( 57/131 ) , 80. 2% (105/131) and 48. 9% (64/131), 83. 2% (109/131), respectively, with a significant difference (P<0. 01). The positive rate of p27 and PTEN in laryngeal carcinoma tissues of the recurrent group and non recurrent group was 20. 0% (4/20), 47. 7% (53/111) and 10. 0% (2/20), 55. 9% (62/111), respectively, with a significant difference (P<0. 05). While the positive rate of p27 and PTEN in tumor resection marginal tissues of the recurrence group and non recurrence group was 50. 0% ( 10/20 ) , 85. 6% ( 95/111) and 40. 0% (8/20), 91. 0% (101/111), the difference was also statistically significant (P<0. 01). Conclusions There was no statistically significant difference in tumor recurrence rate between CO2 laser surgery and traditional split laryngeal surgery. Postoper-ative recurrence is closely related to resume smoking. The recurrence rate of p27 and/or PTEN negative patients was higher than that of the opposite ones which should be followed up closely after treatment.