经口低温等离子手术治疗侵犯前连合的早期声门型喉癌

摘要

目的 探讨经口低温等离子手术治疗侵犯前连合的早期声门型喉癌的技术要点和临床疗效.方法 收集解放军总医院第一附属医院2010年1月至2016年3月接受经口低温等离子手术治疗的31例声门型喉癌患者的临床资料.按照是否侵犯前连合分为2组,前连合受侵组11例, TNM分期为T1a 1例,T1b 3例,T27例;前连合未受侵组20例,TNM分期为Tis 3例,T1a 10例,T27例.所有病例均接受经口低温等离子手术治疗,术后进行严密随访,1例患者术后接受放疗.采用SPSS 19.0统计软件对所有数据进行统计学分析.结果 随访时间12~67个月,中位时间30个月.11例侵犯前连合的声门型喉癌患者中9例获得良好的肿瘤控制效果,2例T2期患者肿瘤局部复发接受喉全切除术;20例前连合未受侵患者术后复发2例,分别为T1a 1例,T2期1例,1例接受同侧择区性颈淋巴清扫术,1例接受喉全切除术.前连合侵犯组表现为肿瘤易局部复发、全喉保留较难,但差异无统计学意义(P>0.05).结论 前连合受侵的声门型喉癌并非低温等离子微创手术的禁忌,在角度喉内镜辅助下等离子刀头的可塑性使得其在处理前连合这一狭窄空间具有一定技术优势,在保留喉功能的基础上可获得较好的局部肿瘤控制效果.%Objective To explore the key technique and outcome of transoral radiofrequency ablation microsurgery for early stage of glottic carcinoma with anterior commissure involvement(ACI). Methods A retrospective analysis was conducted on 31 patients,who were diagnosed as early stage glottic carcinoma during January 2010 to March 2016 in ENT Department.According to whether the anterior commissure was involved or not,two groups were divided.There were eleven cases with ACI(stages T1a, T1b,and T2).Twenty cases without ACI(stages Tis, T1a, and T2).All the patients received transoral radiofrequency ablation microsurgery and followed up closely.Only one case received radiotheraphy after surgery.SPSS19.0 software was used to analyze data.Results The follow-up time was 12-67 months, and the median follow-up time was 30 months.Nine among 11 cases with ACI obtained good oncologic outcomes,initial local recurrence was identified in 2/11 cases,including 2 cases of T2.Two cases ultimately required salvage total laryngectomy.Meanwhile,initial local recurrence was identified in 2/20 cases without ACI,including 1 case of T1a and 1 case of T2.One case underwent elective neck dissection, and another one received salvage total laryngectomy.Compared to the patients without ACI,it seemed that the cases with ACI always accomponied with a little higher initial local recurrence and lower overall laryngealpreservation, but the difference had no significance(P>0.05).Conclusions Transoral radiofrequency ablation microsurgery is an effective treatment for glottic carcinoma with ACI.Its advantages,such as more flexibility and deformability,make it more feasible to operate at the narrow space of anterior commissure assisted with laryngeal endoscopy.Good oncologic outcomes can be obtained by this technique with lower initial local recurrence as well as higher overall laryngeal preservation rate.